The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated in routine practice

There is increasing interest in questions about how far the demonstrated efficacy of psychological therapies in research trials can be translated into clinical effectiveness in routine practice. This paper summarises outcome data from several hundred patients treated with CBT in routine clinical practice in a National Health Service psychology service, and compares their outcomes with some of the published research. Although the data have flaws common in ordinary clinical practice (no untreated controls, missing data, uncontrolled pharmacotherapy, etc.), the analyses suggest that CBT in this context is an effective treatment, albeit with probably not quite such good results as it achieves in research trials. Using clinical significance statistics on standardised measures, about half of the sample reliably improved over a course of therapy, including about a third who recovered to normal range.     

Breast Cancer and the Descent: The Loss and Return of Spring

This article approaches breast cancer as an initiation into a healing process that provides the opportunity for the transformation of a basic fault in the personality. Breast cancer will be approached as a metaphor alerting one to a crises of interiority, a loss of connection to ones inner dimension and ones feminine consciousness. This metaphor contains both the loss of the connection and the possibility of its recovery. The process involves a velocity of descent very difficult to endure; it involves a profound and accelerated unraveling of the rationality that previously served as a container stabilizing the ego. The perilousness of the descent imagery reflects the precipitousness of this unraveling. The precipitous descent is seen as an attempt of the soul to heal and reintegrate the personality by revisiting and illuminating a space abandoned long ago. The integration of this part of the personality results in a return of generativity, energy, and creativity.     

Performance and Private Speech of Children with Attention-Deficit/Hyperactivity Disorder While Taking the Tower of Hanoi Test: Effects of Depth of Search,Diagnostic Subtype,and Methylphenidate

We administered the Tower of Hanoi to demographically comparable samples of control participants (n = 34) and children with the Combined (n = 22) and Inattentive subtypes (n = 19) of Attention-Deficit/Hyperactivity Disorder (ADHD). Controls excelled over children with the Inattentive subtype, who outperformed patients with the Combined subtype. These results replicated findings of greater executive deficits in the Combined than in the Inattentive type of ADHD. Double-blind administration of methylphenidate improved task performance only for patients with the Inattentive subtype. In a drug-free Baseline session, children with both subtypes of ADHD made more private verbalizations than controls, particularly when failing puzzles. In later sessions, regardless of drug condition, the inattentive sample exhibited a smaller increase in self-regulatory utterances under failure. In contrast, the combined sample decreased self-regulatory verbalizations under failure only under methylphenidate. The results support some differences between the two subtypes of ADHD in executive functioning and in their response to stimulant therapy. Portions of these results were submitted as part of H. Theresa Chang's PhD dissertation (Chang, 2000) and Helena Kopecky's unpublished master's research, both conducted at the University of Rochester and supervised by Rafael Klorman.     

Modulation of the effective salience of a stimulus by direct and associative activation of its representation

In 2 experiments, rats received exposure to presentations of a footshock preceded by a given cue. In the PRf (partial reinforcement) condition, this cue also occurred in the absence of the shock; in the CRf (continuous reinforcement) condition, it did not. Subsequent testing in which a new stimulus was used to signal the shock (Experiment 1) showed that the shock was more effective as a reinforcer for the PRf than for the CRf group. In Experiment 2, the shock was used as a conditioned stimulus signaling food delivery, and it was found that conditioning occurred more readily in the PRf than in the CRf group. These results accord with the hypothesis that preexposure to the shock results in a decline in its effective salience but that experience of a cue that signals shock in the absence of the shock itself attenuates this effect and helps maintain stimulus salience.     

Individual differences in the emergence of depressive symptoms in children and adolescents: a longitudinal investigation of parent and child reports

The authors address questions about the rate that depressive symptoms emerge, developmental and gender differences in this rate, and differences between parent and child estimates of this rate. In a 12-wave, cohort-sequential, longitudinal design, 1,570 children (Grades 4-11) and parents completed reports about children's depression. Cross-domain latent growth curve analysis revealed that (a) the rate of symptom growth varied with developmental level. (b) gender differences symptom growth preceded emergence of mean level gender differences, (c) the rate of symptom development varied with age, and (d) parent-child agreement about rate of symptom change was stronger than agreement about time-specific symptoms. The authors suggest that predictability of depressive symptoms varies with age and the dimension under investigation.     

The disclosure dilemma for gay men and lesbians: "coming out" at work

This study examined disclosing sexual orientation at work for 220 gay men and 159 lesbians. Self-acceptance, the centrality of one's identity, how "out" one is to friends and family, employer policies, and perceived employer gay-supportiveness were associated with disclosure behaviors at work for gay/lesbian employees. Disclosing at work and working for an organization perceived to be more gay supportive was related to higher job satisfaction and lower job anxiety. Reactions of coworkers to gay or lesbian workers mediated the relationship between disclosure and gay/lesbian workers' job attitudes. Implications and solutions for management are discussed.     

Bringing culture to basic psychological theory--beyond individualism and collectivism: comment on Oyserman et al. (2002)

D. Oyserman, H. M. Coon, and M. Kemmelmeir (2002) offered a comprehensive literature review on individualism and collectivism that forwards valuable suggestions for ways to enhance future research conducted within this framework. The author argues that although their criticisms of much contemporary social psychological research on individualism and collectivism are valid, even more fundamental problems need to be recognized as characterizing work within this tradition, such as the insufficiently subtle nature of the views held of culture, the limited attention given to meanings, and the downplaying of contextual variation. The author suggests adopting more nuanced and process-oriented conceptions of culture and more contextually grounded views of its impact on psychological functioning as a way of realizing the promise of cultural psychology to broaden and provide insight into basic psychological theory.     

Using information theory to assess the diversity,complexity, and development of communicative repertoires

The application of quantitative and comparative measures from information theory on animal communication can provide novel insights into the ecological, environmental, social, and contextual properties that shape the structure, organization, and function of signal repertoires. Using 2 phylogenetically different mammalian species that share similar ecological and social constraints as examples, the authors quantitatively examined the internal structure and development of a subsystem of these species' vocal repertoires in comparison with that of human language and illustrated that these species exhibit convergent developmental processes. The authors also discussed how predictions on the structure and organization of animal communication systems can be made from this new application of information theoretic measures with respect to behavioral ecology.     

Death in a religious community

Within the experience of all religions, death and loss are a constant of the human condition. Most religions have developed strategies for helping members who are experiencing the pain of loss. Within Ethical Humanism, a non-atheistic religion, the reliance on community has been the major source of support and coping for members within each Ethical Society. This article explores the concept of community within Ethical Humanism, developed and articulated through the pastoral role, and applies it to the experiences of two prominent members of the Ethical Society.     

Developmental profiles of peer social preference over the course of elementary school: associations with trajectories of externalizing and internalizing behavior

Using a new longitudinal clustering technique, this study aimed to (a) empirically identify groups of children with distinct longitudinal profiles of peer social preference during elementary school; (b) compare these groups regarding their longitudinal pattern of classification into J. D. Coie, K. A. Dodge, and H. Coppotelli's (CDC; 1982) sociometric categories; and (c) compare these groups regarding their longitudinal trajectories of antisocial, hyperactive, and anxious behavior. Based on 299 children, 3 groups were identified: a stable popular group, a stable average group, and an unpopular group whose social preference decreased over time. Each of the groups showed considerable overlap over time with their closest corresponding CDC category (popular, average, rejected). Growth curve analyses showed that externalizing and internalizing behavior generally decreased over time, but overall means and the rates of decrease differed in the 3 groups.