Rumination-focused cognitive behaviour therapy for residual depression: a case series

The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.     

The revelation effect: Moderating influences of encoding conditions and type of recognition test

In the revelation effect, slowly revealing a test item immediately prior to a recognition judgment increases the probability of an “old” response. Extant accounts imply that the revelation effect occurs for familiarity-based judgments but not for those involving recall or recollection. To assess this implication, the contribution of recollection was varied by encoding conditions and memory tests. Two manipulations of recollection, semantic encoding and context-item integration, both reduced the revelation effect on a standard recognition test. For the same encoding conditions, a perceptually driven memory test (rhyme recognition) exhibited no revelation effect whatsoever. In a second experiment, the rhyme recognition test exhibited a revelation effect under impoverished encoding conditions. The results document important limits of the revelation effect produced by both encoding and test conditions. Furthermore, the recollection-based limitations of the revelation effect are not restricted to conditions of enhanced semantic encoding.     

The River Model: A Metaphor and Tool for Training New Psychotherapists

A conceptual frame of reference called The River is presented for training of beginning psychotherapists. Using metaphors, trainees are taught specific tools (Equipment) and to identify salient features of the therapy process (Topography) by means of a series of metaphors for the process elements of timing and of level of intervention. Student therapist feedback indicated that this model facilitated learning of how much or little to do at given points in the therapeutic process, and that these metaphors appeared to transcend specific theoretical orientations.     

Dude looks like a lady: Exploring the malleability of person categorization

Recent research has documented how single facial features can trigger person categorization. Questions remain, however, regarding the automaticity of the reported effects. Using a modified flanker paradigm, the current investigation explored the extent to which hair cues drive sex categorization when faces comprise task‐irrelevant (i.e., unattended) stimuli. In three experiments, participants were required to classify target forenames by gender while ignoring irrelevant flanking faces with and without hair cues. When present, hair cues were either congruent or incongruent with prevailing cultural stereotypes. The results demonstrated the potency of category‐specifying featural cues. First, flanker interference only emerged when critical hair cues were present (Experiment 1). Second, flankers with stereotype‐incongruent hairstyles (e.g., men with long hair) facilitated access to information associated with the opposite sex (Experiment 2), even when the flankers were highly familiar celebrities (Experiment 3). The theoretical implications of these findings are considered. Copyright © 2009 John Wiley & Sons, Ltd.     

Reduced misinformation effects following saccadic bilateral eye movements

The effects of saccadic bilateral (horizontal) eye movements on memory for a visual event narrative were investigated. In the study phase, participants were exposed to a set of pictures accompanied by a verbal commentary describing the events depicted in the pictures. Next, the participants were asked either misleading or control questions about the depicted event and were then asked to engage in 30s of bilateral vs. vertical vs. no eye movements. Finally, recognition memory was tested using the remember-know procedure. It was found that bilateral eye movements increased true memory for the event, increased recollection, and decreased the magnitude of the misinformation effect. The findings are discussed in terms of source monitoring, dual-process theories of memory and the potential neural foundations of such effects.     

The Relationship Between Caregiver Capacity and Intensive Community Treatment for Children with a Mental Health Crisis

We studied 9,220 children referred to a comprehensive mental health crisis stabilization program to examine the impact of caregiver capacity on crisis worker decisions to refer children for intensive community-based treatment as opposed to inpatient psychiatric hospitalization. Due to the different role of caregivers in the child welfare system, analyses were stratified by state custody status. Among both groups, there was a significant inverse association between child mental health need and referral to intensive community-based treatment. For children not in state custody with low mental health need, there was no difference in the likelihood of referral to intensive community-based treatment across levels of caregiver capacity. However, for children not in state custody with medium and high mental health needs, those whose caregivers were deficient or severely deficient were significantly more likely to be referred for intensive community-based treatment than were those who had capable caregivers. Multivariate analyses demonstrated similar results after controlling for potential confounding variables and confirmed that caregiver capacity contributes significantly to the logistic model’s classification accuracy. Results suggest further investigation of the impact of caregiver capacity on mental health crisis worker referral decisions is needed.     

Translating Evidence to Practice: Two Stories from the Field

Translating research evidence into daily practice is a challenging process at the organizational level. Conceptual models about this process point to the importance of resources for change and environmental influences as two key factors that need to be addressed in translation efforts. Two organizational case studies focused on improving care for adults with depression are described that illustrate lessons about translating evidence to practice that may be helpful to others.