Counselling in primary care: a systematic review of the research evidence

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Counselling (or equivalent) provided non-directive counselling in primary care. Four trials met the inclusion criteria. Results indicated that patients who receive counselling show a modest but significant improvement in symptom levels compared with those who receive GP care. Levels of satisfaction with counselling are high. There is very tentative evidence to suggest that counselled patients are more likely to be considered recovered than usual GP care patients. There is limited information about the cost-effectiveness of counselling. We conclude by reflecting upon the results of the review and their implications for counselling research.     

Effects of acceptance-oriented versus evaluative emotional processing on heart rate recovery and habituation

The effects of emotional processing on stress response trajectories may depend on the nature of processing, as evaluative rumination about emotions can prolong distress. In contrast, observing negative emotions in an accepting manner may promote efficient recovery from stressful situations. The present study examined the effect of acceptance-oriented versus evaluative emotional processing on cardiovascular habituation and recovery. Across two experimental sessions, 81 participants were randomly assigned to write about an ongoing stressful experience while either (1) evaluating the appropriateness of their emotional response (EVAL), (2) attending to their emotions in an accepting way (ACC), or (3) describing the objective details of the experience (CTL). Heart rate was assessed continuously throughout baseline, writing, and recovery. Results suggest that writing about emotions in an evaluative way leads to less efficient heart rate habituation and recovery than processing emotions in an accepting manner. These findings highlight a potential mechanism of mindfulness- and acceptance-based interventions' effects on health outcomes and further suggest that habitually evaluating the appropriateness of one's emotional responses rather than accepting them as they unfold may have consequences for cardiovascular health.     

Implicit memory for negative and positive social information in individuals with and without social anxiety

Studies of memory bias for threat-relevant information in individuals with social anxiety have produced mixed results. These discrepancies may be because investigators have studied different memory processes or have used different memory tasks. We employed a video clarity judgement task to investigate implicit (capacity-free, automatic, unconscious) memory and a recognition task to investigate explicit (effortful, strategic, conscious) memory for threat in socially anxious individuals and nonanxious controls. Implicit memory for "old" (i.e., seen before) videos was defined as rating "old" videos as more clear than "new" (i.e., never seen before) videos. We created brief video clips that involved an actor or actress approaching the camera and commenting on some aspect of the viewer's actions, physical appearance, or belongings. Twenty-four videos were positive (e.g., "I really like your shoes"), and 24 were negative (e.g., "That is a horrible haircut"). Results revealed that the video clarity test was an effective measure of implicit memory. Furthermore, socially anxious individuals showed a larger implicit memory index for negative videos than did nonanxious and dysphoric controls. No group differences emerged for implicit memory for positive videos. Similarly, groups did not differ in recognition of, or false alarms for, positive and negative videos. These results demonstrate the role of implicit memory in social anxiety implying that information about threat may be automatically primed in these individuals.     

Congruency effects in part-list cuing inhibition.

In demonstrations of part-list cuing inhibition, subjects who are shown a subset of studied list words recall fewer noncue words than subjects not shown such part-list cues. We propose that part-list inhibition is governed in part by an incongruency principle: Inhibition occurs to the extent that part-list cues induce a retrieval framework different from that used to encode list items. In Experiment 1, word lists were studied followed by a test of free recall either without cues, or with cue words serially organized to be either congruent or incongruent with the order of studied items. In Experiments 2-4, cues consisted of every second study item in the original presentation order (congruent ones) or reordered to form famous names or familiar idioms that had been hidden in the study list (incongruent cues). More part-list inhibition was observed with incongruent cues than congruent cues in all 4 experiments.     

THE EFFECTS OF PERCEIVED JOB AVAILABILITY FOR WOMEN ON COLLEGE WOMEN'S ATTITUDES TOWARD PRESTIGIOUS MALE-DOMINATED OCCUPATIONS

This study investigated the effects of perceived job availability for women and sex role orientation on college women's evaluations of highly prestigious male-dominated occupations. In a mixed design, feminine, androgynous, and masculine women (as determined by the Personal Attributes Questionnaire) evaluated two professions described as providing good opportunities for women, two described as providing average opportunities, and two described as providing poor opportunities. Subjects were most likely to want to pursue occupations with good job availability for women and to expect the most intellectual stimulation and approval from others as a result of pursuing these occupations. In addition, sex role orientation was related to expectations concerning intellectual stimulation and approval from others but did not interact with level of job opportunity on any of the dependent measures.     

Improving recall by recoding interfering material at the time of retrieval.

Our experiments demonstrate that interference of an interpolated list of items with recall of an original list can be substantially reduced by forming Ss just before testing how to reorganize and simplify the interpolated material. In Experiments 1 and 2, Ss better recalled an initial serial list of letters when informed at testing that an interpolated list spelled a certain phrase backward. Similarly, in Experiments 3 and 4, Ss better recalled an initial list of cities when told that the interpolated cities were also names of former U.S. presidents. Control experiments rule out several simple explanations. In contrast to an editing hypothesis, the postorganizing clue helped recall even when problems of list differentiation were minimized. Current memory models appear unable to explain this benefit of a postlearning clue that enables Ss to segregate the interpolated material from the to-be-remembered material.     

Novelty and frequency as determinants of newborn preference

The debate over whether infants prefer a familiar stimulus over a novel stimulus has persisted for over 30 years, and there is evidence which supports both sides of the question. However, the research which supports the preference for the familiar uses different measures than that which supports the preference for novelty. In the first experiment, the preference for the familiar was tested by making one stimulus more familiar than the others presented. A target of a ‘familiar’ face was presented eight times more frequently than the other faces. During the experiment, the infants could choose at which face they looked and for how long. It was found that the infants significantly preferred the familiar face over any one of the novel faces, especially when the familiar face was presented first. Substituting auditory for visual stimuli, the second experiment was a replication of the first experiment. Consonant–vowel syllables were used instead of faces. Overall, 17 stimuli were used: one repeating ‘familiar’ sound, and 16 novel sounds. It was found that the infants significantly preferred the familiar sound over any of the novel sounds. As found in Experiment 1, the infants also had a greater preference for the familiar sound when it was presented first.     

A propositional theory of recognition memory

This paper modifies the Anderson and Bower (1972) theory of recognition memory for words. A propositional representation is outlined for the contextual information underlying word recognition. Logical arguments are offered for preferring this representation over the undifferentiated associative representation used earlier. The propositional representation is used to interpret effects of verbal context upon recognition memory. The implications of these context effects are considered for two-process models of recall and recognition.