A Model of Therapist Competencies for the Empirically Supported Interpersonal Psychotherapy for Adolescent Depression

In order to treat adolescent depression, a number of empirically supported treatments (ESTs) have been developed from both the cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT-A) frameworks. Research has shown that in order for these treatments to be implemented in routine clinical practice (RCP), effective therapist training must be generated and provided. However, before such training can be developed, a good understanding of the therapist competencies needed to implement these ESTs is required. Sburlati et al. (Clin Child Fam Psychol Rev 14:89–109, 2011) developed a model of therapist competencies for implementing CBT using the well-established Delphi technique. Given that IPT-A differs considerably to CBT, the current study aims to develop a model of therapist competencies for the implementation of IPT-A using a similar procedure as that applied in Sburlati et al. (Clin Child Fam Psychol Rev 14:89–109, 2011). This method involved: (1) identifying and reviewing an empirically supported IPT-A approach, (2) extracting therapist competencies required for the implementation of IPT-A, (3) consulting with a panel of IPT-A experts to generate an overall model of therapist competencies, and (4) validating the overall model with the IPT-A manual author. The resultant model offers an empirically derived set of competencies necessary for effectively treating adolescent depression using IPT-A and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines. This model, therefore, provides an empirical framework for the development of dissemination and implementation programs aimed at ensuring that adolescents with depression receive effective care in RCP settings. Key similarities and differences between CBT and IPT-A, and the therapist competencies required for implementing these treatments, are also highlighted throughout this article.     

Mere presence is not enough: Responsive support in a virtual world

When individuals are faced with novel or threatening situations, the presence of a trusted companion should reduce anxiety and promote feelings of security. Attachment theory assumes, however, that mere presence is not sufficient for establishing security; an attachment figure must also be attentive and emotionally responsive. To test this idea, participants came to the lab with their romantic partner and completed a threatening cliff-walking task in a digital immersive virtual environment. The presence and nonverbal support behavior (attentive vs. inattentive) of their partner was experimentally manipulated. Results indicated that participants in the attentive-partner condition experienced the task as less stressful than those who were alone; they also reported feeling more secure during the task and were less vigilant of their partner's behavior compared to those in the inattentive-partner condition. Those in the inattentive-partner condition felt less cared for and kept greater physical distance from their partner on a subsequent task. These findings suggest that human beings are predisposed to monitor their social environment for signs of responsiveness, and that perceived responsiveness, not mere presence, is the key modulator of emotional security.     

A Business Model for Managing System Change Through Strategic Financing and Performance Indicators: A Case Study

This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity to reform its children's system. A cross-system response to the crisis is outlined that includes a system of care framework coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies, and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were diverted from residential care and served in the community. The article offers a number of recommendations for other communities contemplating system change.     

Asymmetric switch-costs and ERPs reveal facial identity dominance over expression

Previous studies on face processing have revealed an asymmetric overlap between identity and expression, as identity is processed irrespective of expression while expression processing partly depends on identity. To investigate whether this relative interaction is caused by dominance of identity over expression, participants performed familiarity and expression judgments during task switching. This paradigm reveals task-set dominance with a paradoxical asymmetric switch-cost (i.e., greater difference between switch and repeat trials when switching toward the dominant task). Event-related potentials (ERPs) were recorded to find the neural signature of the asymmetric cost. As expected, greater switch-cost was shown in the familiarity task with respect to response times, indicating its dominance over the expression task. Moreover, a left-sided ERP correlate of this effect was observed at the level of the frontal N2 component, interpreted as an index of modulations in endogenous executive control. Altogether, these results confirm the overlap between identity and expression during face processing and further indicate their relative dominance.     

Initial validation of a measure of self-efficacy in romantic relationships

This study examines the psychometric properties of a self-report measure of self-efficacy in romantic relationships (SERR). Analyses (with 775 undergraduates) indicated a coherent factor structure representing broad beliefs about task demands in romantic relationships and abilities to meet such demands. SERR scores predict relationship anxiety and expectations of relationship success when demographic characteristics, current romantic relationship status, general self-efficacy, and social self-efficacy are considered. The SERR assesses broad feelings of relationship self-efficacy, independent of specific relationships or partners, important for understanding individual-level relationship expectations, behaviors, and interventions.     

The influence of speaker gaze on listener comprehension: Contrasting visual versus intentional accounts

Previous research has shown that listeners follow speaker gaze to mentioned objects in a shared environment to ground referring expressions, both for human and robot speakers. What is less clear is whether the benefit of speaker gaze is due to the inference of referential intentions (Staudte and Crocker, 2011) or simply the (reflexive) shifts in visual attention. That is, is gaze special in how it affects simultaneous utterance comprehension? In four eye-tracking studies we directly contrast speech-aligned speaker gaze of a virtual agent with a non-gaze visual cue (arrow). Our findings show that both cues similarly direct listeners’ attention and that listeners can benefit in utterance comprehension from both cues. Only when they are similarly precise, however, does this equality extend to incongruent cueing sequences: that is, even when the cue sequence does not match the concurrent sequence of spoken referents can listeners benefit from gaze as well as arrows. The results suggest that listeners are able to learn a counter-predictive mapping of both cues to the sequence of referents. Thus, gaze and arrows can in principle be applied with equal flexibility and efficiency during language comprehension.     

Blended courage: Moral and psychological courage elements in mental health treatment seeking by active duty military personnel

We propose that seeking mental health care in an environment with heightened stigma may combine elements of both psychological and moral courage. Interviews of 32 active duty US Army personnel about their process of seeking current mental health care were analyzed for themes of voluntary action, personal risk, and noble or worthwhile goals (benefits). Risks and benefits were divided into internal risks and benefits, characteristic of psychological courage; and external risks and benefits, characteristic of moral courage. Concerns about external risks were themes in all narratives, while concerns about internal risks were themes in only about half of narratives. Both internal and external benefits of treatment were themes in approximately three-quarters of the narratives, whereas doubts about internal (but not external) benefits were also expressed at a similar rate. Thus, participants described an act of blended courage, with social risks of moral courage taken for wellness goals of psychological courage.     

The impact of empathy on burnout in medical students: new findings

Introduction: Research on medical students has shown they are at a higher risk for burnout and that this burnout may become more prevalent as they advance in medical school. The literature, thus far, has not explored the construct of ,emotional empathy and whether this can impact burnout in medical students. Objective: To understand the relationship between empathy (Empathic Concern [EC] and Personal Distress [PD]) and burnout in medical students. Method: Five successive classes of medical students enrolled at a new medical school were given the Maslach Burnout Inventory and Davis’ Interpersonal Reactivity Index over the course of three successive years (n = 353). Two dimensions of empathy were evaluated to determine if they have an impact on three dimensions of burnout (Emotional Exhaustion/EE, Depersonalization/DP, Personal Accomplishment/PA). Results: data was analyzed using a linear mixed model for each of the three components of burnout based on gender, age, year in medical school, and two types of empathy: EC, and PD. Conclusion: It was discovered that students with high levels of EC had statistically lower scores of burnout over time while students with high levels of PD empathy showed statistically higher scores of burnout over three years. Implications for these findings are discussed.     

Virtual Reality and Cognitive-Behavioral Therapy for Driving Anxiety and Aggression in Veterans: A Pilot Study

Within the U.S. military, motor vehicle accidents (MVAs) are the leading cause of preventable morbidity and mortality. Prior combat exposure and anxiety symptoms are associated with risky and aggressive driving, which is responsible for over half of MVA fatalities. Therefore, interventions are needed to reduce driving anxiety and aggression in veterans in order to mitigate the public health impact of MVAs. Virtual reality exposure therapy (VRET) offers safe, controlled exposure to distressing stimuli. The current study piloted a novel virtual reality and cognitive behavioral intervention (VRET + CBT) for veterans that integrated both anxiety and anger management components. Virtual reality driving scenarios were delivered in a driving simulator and tailored for the military population. Six previously deployed veterans completed eight intervention sessions, as well as pre/post, one month follow-up and six to nine month follow-up assessments. Repeated measures ANOVAs demonstrated significant decline and large effect sizes for PTSD symptoms, driving phobia, hyperarousal in driving situations, anxiety/anger-related thoughts and behaviors, and risky driving. Hyperarousal in driving situations declined by 69%, aggressive driving declined by 29%, and risky driving declined by 21%. Treatment gains were maintained at follow-up. Recruitment, retention, immersion, simulator sickness scores, and qualitative feedback demonstrated feasibility of the intervention. Implications for future research and adaptation are discussed.     

Capturing a More Complete View of Employees’ Lives Outside of Work: The Introduction and Development of New Interrole Conflict Constructs

This research introduces 4 new constructs that reflect interrole conflict (i.e., work‐to‐personal, personal‐to‐work, family‐to‐personal, and personal‐to‐family conflict) and provide a more complete view of the roles and responsibilities employees experience outside of work. An integration of interrole conflict literature and research on work and nonwork roles or domains highlights the importance of considering an individual's personal domain, which includes activities one pursues because of his or her own interests (e.g., friends, hobbies, community). Unfortunately, without conflict measures pertaining to this new role, researchers cannot clearly understand how roles other than family interfere with individuals’ work role including how interrole conflict impacts employees who do not have significant responsibilities in the family domain. Five phases of research across 4 separate samples were conducted in order to develop measures for the 4 new conflict constructs and to examine relationships with important work, family, life, and health outcomes. Findings from multisource data, including self‐rated, coworker‐rated, as well as single and nonsingle participants, show that the 4 new forms of interrole conflict have significant implications for employees and organizations.