Comparing Alliance in Two Cognitive-Behavioural Therapies for Adolescents With ADHD Using a Randomized Controlled Trial

Alliance is defined as the client-therapist bond and their ability to collaborate on therapeutic activities. Treatment for adolescents with ADHD is rarely studied in terms of alliance. In this study, two cognitive-behavioral treatments (CBT; one structured treatment aimed at planning skills and one less-structured solution-focused treatment, both delivered in the style of Motivational Interviewing) were compared with regard to alliance and alliance-outcome association. The influence of therapist competence on this alliance-outcome association was also evaluated. The alliance between 69 adolescents diagnosed with ADHD and their therapists was measured early in treatment, using the Therapy Process Observational Coding System for Child Psychotherapy–Alliance scale. Observer-rated therapist competence was measured using the Motivational Interviewing Treatment Integrity scale (version 3.1.1.). Outcome variables were the adolescents’ reduction in planning problems and ADHD symptoms. The alliance, and, more specifically, collaboration on therapeutic activities, was significantly higher for the more structured CBT (p = .04; moderate effect size). Alliance was not related to outcome in the more structured CBT, while the alliance was positively related to the reduction in planning problems in the less structured CBT. Finally, alliance was a significant mediator between therapist competence and treatment outcome for the less-structured CBT. The clarity and structure of CBT may help facilitate alliance formation for adolescents with ADHD who often have difficulty implementing structure themselves. Therapists may need to invest more in alliance formation in less structured CBT as the alliance affects outcome. Moreover, enhancing therapist competence in less structured CBT may help improve outcomes in less structured CBT, as therapist competence may impact outcome through alliance.     

Affect and between-meal snacking in daily life: the moderating role of gender and age

Objective: Affect-related energy intake from snacks remains relatively unexplored in daily life. This study examines the associations between momentary positive affect (PA) and momentary negative affect (NA) and subsequent energy intake from snacks. In addition, the moderating role of BMI, gender, age and level of education is investigated.

Design: Adults (N = 269), aged 20–50, participated in this study. Demographics were assessed in an online composite questionnaire. An experience sampling smartphone application was used to map momentary NA/PA and energy intake (kilocalories) from snacks in the context of daily life.

Main outcome measures: Energy intake from moment-to-moment self-reported snacks in real-life settings.

Results: A significant negative main effect of momentary NA on moment-to-moment energy intake was found. The higher the momentary NA, the lower the subsequent amount of kilocalories consumed. There was no main effect with regard to PA. Interaction analyses showed that men decreased their energy intake after experiencing NA, and increased their intake after experiencing PA. No associations were found in women. Additionally, young adults (20–30) increased their energy intake after experiencing PA. No associations were found in the other age groups.

Conclusion: Interventions aiming at reducing energy intake might also address PA-related snacking in young adults and men.     

Effects of a school reform on longitudinal stability of students’ preferences with regard to education

Background . Students’ perspective on education is of crucial importance for its effectivity, but students’ opinions are seldom acknowledged by teachers and designers. Student participation in the educational design process could be a suitable tool to better take students’ preferences into account. However, for effective participatory design, it is necessary to know whether students have stable preferences for the design of their education. Changeability of preferences would require a more continuing design process allowing continuous adaptations. Aims . This longitudinal survey study aimed to determine the changeability over time of students’ preferences for different aspects of a learning environment. Additionally, causes of possible changes in preferences are investigated. Sample . The participants were 1,335 high school students of five schools for secondary education in the Netherlands, joining this study during a period of 2 years. Method . Data about students’ preferences were collected at three moments, using the Inventory of Perceived Study Environment Extended. Learning‐related student characteristics, such as processing strategies and motivational orientations, were measured with the Inventory of Learning Styles. Additionally, data on learning performances were collected. Results . The results showed stability on preferences for almost all studied characteristics of the learning environment. Particularly remarkable was a drop in desirability for student autonomy. This was larger for students with a certificate‐oriented motivation and smaller for self‐regulated students. Additionally, poorly performing students had a larger decrease in preference for autonomy. Conclusions . The stability on most aspects supports that participatory design might result in fairly stable instructional designs, although caution is needed with respect to student autonomy.     

Self-Control and Child Abuse Potential in Mothers with an Abuse History and Their Preschool Children

We examined whether physically and sexually abused mothers display lower levels of self-control, whether this explains their higher tendency to abuse their own children, and if this results in lower levels of self-control among their children. In a cross-sectional study, 40 abused and 47 matched, non-abused mothers completed validated self-control and child abuse potential questionnaires. Their preschool children (2.3–3.7 years) were tested for self-control with the effortful control battery and delay of gratification test. Relationships and mediations were tested using stepwise regression analyses and bootstrap mediation tests, while controlling for potential confounders. Mothers with a history of abuse had a significantly higher potential to abuse their children (p < .001) and lower levels of self-control (p < .05) compared to non-abused mothers. Maternal self-control predicted child abuse potential (p < .001) while controlling for maternal history of abuse, revealing that self-control partially mediated the relation between past abuse and current abuse potential. Next, child abuse potential was found to be a borderline significant predictor of child self-control (p = .05) on the delay of gratification task but not on the effortful control battery. We did not discover a correlation between child self-control and maternal self-control. These findings suggest that self-control may be a potentially important mechanism in the intergenerational cycle of child abuse. Further investigation on the topic is needed to confirm this hypothesis, for example through investigating the impact of parental self-control training on abusive parenting and children’s self-control development. Improved child self-control measures or focusing on older children is expected to address the key limitations of the current study.     

Short-Term Psychoanalytic Supportive Psychotherapy for Depressed Patients

Short-Term Psychoanalytic Supportive Psychotherapy (SPSP) is a face-to-face, individual psychotherapy, consisting of sixteen sessions in six months (first eight weekly, then eight fortnightly sessions). It is rooted in psychoanalytic theory. Its primary aim is to cure depression. A secondary goal is to reduce a patient's vulnerability to depression. The emphasis is on supportive techniques that counter regression and foster psychological growth. The putative process consists in experiencing a relational dissonance, i.e., feeling two contradictory relationships in the therapeutic situation simultaneously, one determined by the past, the other by the present. We assume an important curative factor is to experience, mostly unconsciously, an adequate gratification of developmental needs inadequately met in early infancy and, therefore, manifesting themselves in the archaic aspects of the therapeutic relationship. SPSP unfolds as a discourse in which we distinguish nine levels. Each regards a specific subject, which at that level is the focus of the interaction between patient and therapist. The efficacy of SPSP in ambulatory patients presenting a DSM-IV defined, mild to moderate major depressive disorder has been tested in five randomized clinical trials. The results have been aggregated in a mega-analysis. They suggest that, in the treatment of outpatients with mild to moderate major depressive disorder, SPSP and pharmacotherapy are equally efficacious and that the combination of SPSP and pharmacotherapy is more efficacious than pharmacotherapy alone but not than SPSP alone. We, therefore, consider SPSP a valuable extension to the existing options for the treatment of depressed patients.     

Psychological and Somatic Factors in Patients Undergoing Coronary Artery Bypass Graft Surgery: Towards Building a Psychological Framework

The present study explored the relationships between psychological and somatic factors in patients undergoing Coronary Artery Bypass Graft surgery (CABG). The data-analysis of previous work was extended by adding somatic factors, including feelings of disability, somatic complaints and fatigue. The focus was on their relationships with psychological factors, including anxiety, depression and neuroticism. Prior to surgery and six months postoperatively, 217 patients completed self-report questionnaires. Using the method of structural equation modeling (SEM), the structure of relationships between the somatic, psychological and background factors (i.e., gender, age and medical factors) was explored. A model was developed providing a good fit and accounting for a substantial amount of variance. The structure of relationships revealed that somatic factors lead to anxiety and depression in the preoperative period, whereas anxiety and depression lead to somatic factors in the postoperative period. The structure further strengthened the key position of neuroticism and its overall negative prognostic implications.     

Colour constancy in goldfish and man: influence of surround size and lightness

Colour constancy was investigated by using a series of 10 simultaneously presented surface colours ranging in small steps from green through gray to red-purple. Goldfish were trained to select one medium test field when the entire setup was illuminated with white light. In the tests, either red or green illumination was used. Colour constancy, as inferred from the choice behaviour, was perfect under green illumination when the test fields were presented on a gray or a white background, but imperfect on a black background. Under red illumination and a white background, however, colour constancy was overcompensated. Here, a colour contrast effect was observed. The influence of background lightness was also found when the surround was restricted to a narrow annulus of 4-11 mm width (test field diameter: 14 mm). By applying colour metrics it could be shown that the von Kries coefficient law can describe the overall effect of colour constancy. For an explanation of the effect of surround size and lightness, lateral inhibitory interactions have to be assumed in addition, which are also responsible for simultaneous colour contrast. Very similar results were obtained in experiments with the same colours in human subjects. They had to name the test field appearing 'neutral' under the different illumination and surround conditions, as tested in the goldfish experiment.     

Sketches from a design process: creative cognition inferred from intermediate products

Novice designers produced a sequence of sketches while inventing a logo for a novel brand of soft drink. The sketches were scored for the presence of specific objects, their local features and global composition. Self-assessment scores for each sketch and art critics' scores for the end products were collected. It was investigated whether the design evolves in an essentially random fashion or according to an overall heuristic. The results indicated a macrostructure in the evolution of the design, characterized by two stages. For the majority of participants, the first stage is marked by the introduction and modification of novel objects and their local and global aspects; the second stage is characterized by changes in their global composition. The minority that showed the better designs has a different strategy, in which most global changes were made in the beginning. Although participants did not consciously apply these strategies, their self-assessment scores reflect the stages of the process.     

Self-reported parental abuse relates to autobiographical memory style in patients with eating disorders

Previous research has shown a relationship between levels of self-reported childhood abuse and overgeneral memory style. This relationship was further clarified in patients with an eating disorder (ED). Patients and healthy controls completed a task in which they had to generate specific autobiographical memories to emotional cue words. The results showed that first, the ED group, relative to the controls, produced more first memories that were "overgeneral" and fewer first memories that were specific. Second, in the ED group, the level of self-reported parental abuse was positively correlated with the tendency to produce overgeneral memories to negative cues. This effect remained significant even after levels of depressed mood were controlled for.