Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance

One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from 2 clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. We highlight unique challenges in working with counselors unaccustomed to traditional clinical supervision. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted 1 year following implementation, and interviews with key organization executives and administrators.     

EPISTEMOLOGICAL ORIGINS–EPISTEMOLOGICAL AIMS: RETHINKING POSTMODERN THERAPY IN RESPONSE TO HELD

There has been a great deal of controversy over Barbara Held's use of the term "antirealism" in her now popular critique of postmodern therapy. Many of her respondents have rejected this label, claiming that it restricts the debate and oversimplifies their position. Recognizing that this is so, I nevertheless accept Held's term as a useful signifier of the epistemological framework of postmodern therapy, and, thus, challenge her critique on its own grounds. I argue that Held's critique of this epistemological approach, in fact, misses the epistemological point, targeting ontological issues where there are none, and misinterpreting the original aim behind the shift to epistemological antirealism. It is Held's contention that the antirealist turn aimed at "maximizing individuality" in therapy - a goal which can and should be achieved through realism. Her justification for the latter is a supposed "oscillation" between realism and antirealism in the theory of this movement. To the contrary, l suggest that the aim of this epistemological shift was the resolution of strictly epistemological problems, and that the oscillation that Held identifies is the product of her own conflation of epistemological and ontological issues.     

Women Experiencing Psychological Abuse: Are They a Homogenous Group?

Dichotomizing women as “abused” versus “not abused” assumes that any psychological maltreatment results in similar outcomes. A national sample of women in conflictual relationships completed an online survey. Women with no incidence (N = 33), the lowest quartile (N = 86), and the top quartile (N = 81) of psychological maltreatment demonstrated significant differences in reactions to the maltreatment, mental health indicators, personality variables, perceived harm, problematic relationship schemas, and response styles. Women with no psychological abuse and women in the lowest quartile produced similar scores that were typically distinct from the top-quartile women. Effective treatment of women with lower amounts of psychological abuse might not require a unique intervention likely necessary for women experiencing much psychological abuse.     

Deliberate Self-Harm and State Dissociation: An Experimental Investigation

The purpose of this study was to test the relation between deliberate self-harm (DSH) and state dissociation. Participants (N = 85) were randomly assigned to self-administer either a very mild electric shock below their pain threshold (a no-self-harm control condition) or an electric shock they were told could “cause minor tissue damage that would heal quickly,” but which was in fact equal to a predetermined pain threshold (a DSH condition). After task completion, 42 participants rated the extent of their dissociation before the shock and 43 rated the extent of their dissociation after the shock. Results indicated that women in the DSH group experienced more dissociation compared to men, but only after the shock. Potential reasons for this gender effect are discussed.     

Gender Differences in Reporting Psychological Abuse in a National Sample

Understanding the nature and impact of psychological abuse for males and females is crucial because it might be the precursor of other forms of violence. This study examines reported gender differences in psychologically abusive acts using a national sample of U.S. citizens. The data were collected anonymously from an online administration of the Measure of Psychological Abuse (MPAB). Other measures were included to assess outcomes that might occur due to psychological abuse. Results indicate that there are more similarities than differences in the gender reports of psychological abuse. Compared to males' reports, differences include female reports of certain behaviors leading to more negative emotional and behavioral impact and more negative outcomes due to being in a psychologically abusive relationship.     

Congregational Hermeneutics: A Tale of Two Churches

Abstract

The “AHRC Evangelicalism and Fundamentalism in Britain” (EFB) project ran over two years, from 2008 to 2009. The network addressed the question “To what extent have Evangelicals in Britain been Fundamentalist?”. This article develops one of the project papers. Drawing on my doctoral research, I explore the relationship between Evangelicalism and Fundamentalism through an ethnographic perspective on how two contrasting evangelical congregations did biblical hermeneutics. The congregational hermeneutics approach addresses the mix of hermeneutical discourses, practices, and artefacts within the churches and I show that congregational hermeneutics are revealing for questions of evangelical identity. I maintain that the language of ‘fundamentalising tendencies’ is to be preferred to more static conceptions, which are not well suited for describing dissonant tendencies within congregations. The study supports the view that fundamentalising tendencies are not identical with Evangelicalism and shows that implicit hermeneutical traditions can be found in such churches with the potential to shape broader congregational traditions.     

Effects of religious stigma and harm on perceived psychopathology

Prior research suggests that assessment of the pathology of religious beliefs is influenced by conventionality and harm, with less conventional and more harmful beliefs resulting in higher pathology ratings. This study, involving 313 participants, investigated levels of pathology assigned to religious beliefs when the beliefs were either helpful or less severely harmful than those used in prior research, and when the associated religion was either stigmatised (Islam) or non-stigmatised (Christianity). Results indicate that an attenuated form of harm results in elevated pathology ratings. Furthermore, religious stigma impacts these perceptions when beliefs are harmful but not when beliefs are helpful. Ratings in the harm condition were higher for Christianity than for Islam, suggesting that perceived pathology of religious beliefs may depend less on general stigma assumptions and more on perceived consistency between harmful beliefs and assumed religious schemata.     

The moral psychology of rationing among physicians: the role of harm and fairness intuitions in physician objections to cost-effectiveness and cost-containment

Introduction

Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.

Methods

We mailed an 8-page survey to a random sample of 2000 practicing U.S. physicians. The survey included the MFQ30 and items assessing agreement/disagreement with cost-containment and degree of objection to using cost-effectiveness data to guide care. We used t-tests for pairwise subscale mean comparisons and logistic regression to assess associations with agreement with cost-containment and objection to using cost-effectiveness analysis to guide care.

Results

1032 of 1895 physicians (54%) responded. Most (67%) supported cost-containment, while 54% expressed a strong or moderate objection to the use of cost-effectiveness data in clinical decisions. Physicians who strongly objected to the use of cost-effectiveness data had similar scores in all five of the foundations (all p-values?>?0.05). Agreement with cost-containment was associated with higher mean “harm” (3.6) and “fairness” (3.5) intuitions compared to “in-group” (2.8), “authority” (3.0), and “purity” (2.4) (p?<?0.05). In multivariate models adjusted for age, sex, region, and specialty, both “harm” and “fairness” were significantly associated with judgments about cost-containment (OR?=?1.2 [1.0-1.5]; OR?=?1.7 [1.4-2.1], respectively) but were not associated with degree of objection to cost-effectiveness (OR?=?1.2 [1.0-1.4]; OR?=?0.9 [0.7-1.0]).

Conclusions

Moral intuitions shed light on variation in physician judgments about cost issues in health care.

     

Adults' representations of division facts: a consequence of learning history?

There has been a recent increase in the study of adults' performance on simple division problems. Researchers up to now have focused on the relationship between multiplication and division and have found that multiplication often has a mediating role in the solution of division problems (Campbell, 1997, 1999; LeFevre & Morris, 1999; Mauro, LeFevre, & Morris, 2002). In this study, division was exclusively examined to determine the strategies that are used to solve these problems and to identify factors relating to particular strategy use. Thirty-two participants were asked to solve two sets of 64 simple division problems (from 4 divided by 2 to 81 divided by 9) and error, latency, and strategy report data were collected. Fewer errors were made on easy problems, which were also solved more quickly than difficult problems. Participants used retrieval, multiplication, and other strategies to solve the problems and tended to use retrieval more on easy than difficult problems and used multiplication more on difficult problems than easy problems. Unexpected age differences in strategy use were also found. Older participants tended to rely more heavily on retrieval than younger participants. These results suggest that older participants may have stronger representations for simple division problems than younger participants.