Patient preference as a predictor of outcomes in a pilot trial of person-centred counselling versus low-intensity cognitive behavioural therapy for persistent sub-threshold and mild depression

The aim of this analysis was to explore whether pre-treatment intervention preferences were related to outcomes for patients with persistent sub-threshold and mild depression who received one of two treatment types. Thirty-six patients took part in a two-arm, parallel group, pilot randomized controlled trial that compared short term (3 month and 6 month) outcomes of person-centred counselling (PCC) compared with low-intensity, CBT-based guided self-help (LICBT). Patient preferences for the two interventions were assessed at baseline assessment, and analysed as two independent linear variables (pro-PCC, pro-LICBT). Eight out of 30 interactions between baseline treatment preferences and treatment type were found to be significant at the p < .05 level. All were in the predicted direction, with patients who showed a stronger preference for a treatment achieving better outcomes in that treatment compared with the alternative. However, pro-LICBT was a stronger predictor of outcomes than pro-PCC. The findings provide preliminary support that treatment preferences should be taken into account when providing interventions for patients with persistent sub-threshold and mild depression. It is recommended that further research analyses preferences for different treatment types as independent variables, and examines preferences for format of treatment (e.g. guided self-help vs. face-to-face).     

The Last Dictator Game? Dominance,Reactivity, and the Methodological Artefact in Experimental Economics

The Dictator Game (DG), one of the best-known designs in experimental social science, has been extensively criticized, and declared by some to be defunct, on the grounds that its results are the product of a research artefact. Critics of the DG argue that the behaviour observed in the game (where agents frequently decide to share their money with strangers) is not the outcome of genuine pro-social preferences but must, instead, be interpreted as a response to the cues given by the experimental design, where these cues signal that the game is about ‘sharing’ (i.e. about altruism or pro-social behaviour). Despite this criticism, the DG continues to be extensively used, and some have defended its validity as an instrument capable of measuring the role of social pressure and social norms against economic motivations. This article examines the assumptions implicit in the claim that the DG results are artefactual and spells out the conditions under which the game can be used to test hypotheses about pro-social behaviour. To conclude we show how the DG debate helps to illuminate the pitfalls embedded in the abandonment of the dominance principle, and argue that this is crucial to the expanding agenda of experimental economics.     

Psychoanalysis in Postmodern Times: Some Questions and Challenges

As a consequence of the invitation to contribute this piece of writing, I acknowledge having a postmodern attitude, rather than subscribing to postmodernism as an ideology. The purpose behind this article is to reflect on the impact of postmodern times on psychoanalysis from the starting point of my own conception of psychoanalytic theory and practice. This article looks, in some detail, into the problem of truth in psychoanalysis, the issue of theory building in psychoanalysis in its relation to psychoanalytic practice, and the challenges for psychoanalysis as a pluralistic discipline. It repeatedly states that psychoanalysis evidences extreme theoretical and practical diversity, but no pluralism understood as an attitude and methodology of dialogue between theoretical orientations and practical approaches. The current challenge in psychoanalysis is, precisely, to go beyond postmodernism and to build a true pluralism on the basis on interdisciplinary exchange and collaboration.     

Reducing the risk of bias in health behaviour change trials: Improving trial design,reporting or bias assessment criteria? A review and case study

Objective: It has been suggested that randomised controlled trials (RCTs) of health behaviour change (HBC) interventions are less rigorously designed than – for example– drug trials. This study presents an approach to clarifying whether this is due to poor trial design, incomplete trial reporting and/or the inappropriateness of commonly applied risk of bias assessment criteria.

Design: First, a framework of key sources of bias and common strategies for reducing bias risk is developed based on a literature review. Second, we describe the design of a multi-site RCT evaluating the cost-effectiveness of an HIV-treatment adherence intervention (case study). The choices made by the multidisciplinary team trying to minimise the risk of bias are compared against the risk of bias framework.

Main outcome measures: Implementation of common strategies for reducing the risk of bias in the case study; alternative or additional strategies applied; a justification for each deviation from the risk of bias framework.

Results: Most of the common strategies for reducing the risk of bias could be implemented. Alternative strategies were developed for minimising the risk of performance bias and contamination. Several additional, domain-specific risk of bias strategies were implemented.

Conclusions: The literature provides useful guidance for reducing the risk of bias in HBC trials. Yet, the case study suggests that HBC trial designers may face specific challenges that require alternative/additional measures for reducing the risk of bias. Using the risk of bias justification table (RATIONALE) could lead to better-designed HBC trials, more comprehensive trial reports and the data necessary for evaluating the appropriateness of commonly applied risk of bias assessment criteria to HBC trials.     

Training the next generation of counseling psychologists in the practice of telepsychology

Training programs that integrate the use of technology are needed to prepare students for the future of service delivery in psychology. Training opportunities in telepsychology can equip students to develop, implement, and evaluate innovative modalities for mental health care. However, few options are available for trainees seeking to acquire these experiences, and while guidelines for service provision using technology are emerging, guidelines for and documented examples of training programs in telepsychology are virtually non-existent. The Telehealth Counseling Clinic, located at the Texas A&M Health Science Center, has developed a training model to prepare the next generation of psychologists to work with new technology to provide counseling services to low-income and uninsured individuals living in designated Mental Health Professional Shortage Areas in rural Texas. Training competencies necessary to serve this population through telepsychology are discussed and preliminary evaluation data of the training program are presented.