Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: A randomized controlled trial

ObjectiveThe aim of the current study was to integrate recent developments in the retraining of attentional biases towards threat into a standard cognitive behavioural treatment package for social phobia.Method134 participants (M age – 32.4: 53% female) meeting DSM-IV criteria for social phobia received a 12-week cognitive behavioural treatment program. They were randomly allocated to receive on a daily basis using home practice, either an additional computerised probe procedure designed to train attentional resource allocation away from threat, or a placebo variant of this procedure. Measures included diagnostic severity, social anxiety symptoms, life interference, and depression as well as state anxiety in response to a laboratory social threat.ResultsAt the end of treatment there were no significant differences between groups in attentional bias towards threat or in treatment response (all p's > 0.05). Both groups showed similar and highly significant reductions in diagnostic severity, social anxiety symptoms, depression symptoms, and life interference at post-treatment that was maintained and in most cases increased at 6 month follow-up (uncontrolled effect sizes ranged from d = 0.34 to d = 1.90).ConclusionsThe current results do not indicate that integration of information processing-derived attentional bias modification procedures into standard treatment packages as conducted in this study augments attentional change or enhances treatment efficacy. Further refinement of bias modification techniques, and better methods of integrating them with conventional approaches, may be needed to produce better effects.     

Adolescents,Risk Behaviour and Confidentiality: When Would Australian Psychologists Breach Confidentiality to Disclose Information to Parents?

The protection of confidentiality in psychological practice is vital. However, confidentiality is not absolute and psychologists are permitted to breach confidentiality under particular circumstances. Ethical challenges surrounding confidentiality are complex with adolescent clients, as assessments often consider the risk that adolescents pose to themselves in addition to the risk posed to others. The current study documented situations in which Australian psychologists would breach adolescents' confidentiality to disclose information about risk behaviour to parents, with a focus on situations where adolescents posed a risk to themselves as opposed to other people putting adolescents at risk. A total of 264 Australian psychologists were surveyed online. They were each presented with 68 variations of a vignette about a 15‐year‐old boy who was engaged in risk behaviour and were asked whether they would breach confidentiality in each case. The vignettes covered six behavioural domains (smoking, sexual behaviour, drinking, drug use, suicide, stealing) and varied in behaviour intensity, frequency and duration. Consensus was reached about breaching confidentiality in 16% of cases (related to sexual behaviour, drug use, and suicide). Consensus was reached about not breaching confidentiality in 41% of cases (relating to smoking, sexual behaviour, drug use, suicide, and stealing). In the remaining 43% of cases, significant disagreement occurred (relating to all six behavioural domains). The findings suggest a high degree of variation in opinion about confidentiality with adolescents, emphasising the importance of transparent communication and informed consent. The findings also raise questions about how important consistency of psychological practice is across Australia.     

Psychologists' perspectives on the diagnostic classification of mental disorders: Results from the WHO‐IUPsyS Global Survey

This study examined psychologists' views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD‐11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD‐10 used most frequently by 51% and DSM‐IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD‐11 development and dissemination are discussed.     

Competence in Language at 24 Months: Relations with Attachment Security and Home Stimulation

This study explored the interrelations among attachment, home stimulation, and language development in 58 toddlers (36 medically high risk and 22 low risk) at 24 months of age. The results indicated that there were additive effects of attachment and home stimulation on language competence, especially on receptive abilities. Mothers who had established secure relationships and provided stimulating home environments had children with the highest language scores.     

The creative thinking,environmental frustration,and self‐concept of left‐ and right‐handers

Abstract:

Left‐ (n = 12) and right‐handed (n = 12) college students were compared on creative thinking, environmental frustration, and self‐concept. It was hypothesized that because left‐handers regularly encounter equipment designed for right hand use, these individuals must use creative thinking to successfully interact with the environment. Results indicated that on the Environmental Frustration Questionnaire, left‐handers indicated significantly greater frustration with two of the six categories of objects, namely household tools (p < .005) and classroom desks (p < .005). On the Verbal and Figural Forms of the Torrance Tests of Creative Thinking, lefthanders scored significantly higher on the figural elaboration measure (p < .05). Finally, the hypothesis that handedness plays a larger role in the self‐concept of left‐handers than right‐handers was confirmed. Left‐handers were significantly more likely than right‐handers to mention their handedness when asked to describe themselves (p < .05).     

Treatment Parameters and Structural Change: Reflections on the Psychotherapy of a Male Homosexual

Abstract

Shechter R. A. Treatment Parameters and Structural Change: Reflections on the Psychotherapy of a Male Homosexual. Int Forum Psychoanal 1992;1:197-201. Stockholm. ISSN 0803-706X

Sequential highlights from a four-year treatment period demonstrate specific instances when technique parameters, defined as deviations from psychoanalytic neutrality, triggered the emergence of repressed memories. These memories were connected to forbidden impulses and intense annihilation and castration anxiety. Parameters also functioned to keep anxiety at tolerable levels, allowing the working-through and rechanneling of highly charged libidinal and aggressive wishes and fears, and the establishment of a reparative transference. As the patient explored affect and memory, he incorporated a more benign superego. Drive was neutralized, sublimation occurred, and structural change unfolded. Intrapsychic change led to behavior change. The patient moved from a monogamous, sadomasochistic, homosexual lifestyle to a more positively invested and pleasurable heterosexual relationship.

Treatment was not a defense analysis. The patient's ego structure could not have tolerated the anxiety of a transference neurosis that mirrored the abuse of childhood. The treatment dyad was a reparative force. Parameters indirectly functioned as interpretations of repressed longings, surgically cutting through false self-deception.     

The Top Ten Sales Articles of the 20th Century

The dawn of a millennium brings reflection on accomplishments and progress over the prior century. A common exercise is to identify the “best of the best” in a variety of fields of endeavor (e.g., music, science, art, or literature). In this article we identify the “best of the best” in academic research concerning sales management and professional selling. We conducted a survey of practicing sales academics to identify the “Top 10” sales articles of the century. Each of these articles is briefly reviewed, with attention to its purpose, content and contribution. A citation analysis was also conducted to validate the expert opinion rankings. In total, the results present an intriguing perspective on the accomplishments of the sales academy and its progress as a scholarly community.     

Relationship beliefs and illness appraisals are differentially associated with specific ways of coping in spouses of patients with type 2 diabetes

Using data from 117 spouses of patients diagnosed with type 2 diabetes and multiple-group path analysis, the current study explored the association of four relationship beliefs (satisfaction, sacrifice, confidence and instability) and four diabetes appraisals (consequences, distress, control and efficacy) with illness-specific coping behaviour: active engagement, protective buffering and overprotection. The potential moderating effect of gender was also tested. Results indicated gender did moderate the associations among the variables in the model, with the association of relationship satisfaction and active engagement being significantly stronger for men, while diabetes control was more strongly related to protective buffering for women. The only variables associated with active engagement were three relationship-specific cognitions: higher levels of relationship satisfaction (for men only), satisfaction with sacrifice and relationship confidence were all related to higher active engagement. The diabetes appraisals were the only variables associated with protective buffering and overprotection. Higher diabetes distress and diabetes control (for women only) and lower diabetes efficacy were predictive of greater protective buffering. Lower diabetes efficacy and higher diabetes control were associated with greater overprotection. Implications for theory, research and practice are discussed.     

Staff support in medical oncology: A problem-solving approach

Abstract

At a time of low morale the multidisciplinary staff working on a medical oncology rated the severity and frequency of problems arising in their working environment and their personal levels of stress and job satisfaction. An anonymous paper and pencil exercise was used to identify problems at work and possible solutions which staff then discussed as a group. Within four months some changes were implemented resulting in a significant reduction in problems on the unit and a commensurate improvement in morale. Interdisciplinary communication particularly benefited. This problem solving approach was useful in overcoming initial resistance to seeking a cooperative solution to shared problems at work.