Dissemination and Implementation of Cognitive Behavioral Therapy for Depression in the Kaiser Permanente Health Care System: Evaluation of Initial Training and Clinical Outcomes

Notwithstanding its empirical status and strong recommendation in clinical practice guidelines, cognitive behavioral therapy (CBT) continues to be delivered infrequently and with low fidelity on the clinical front lines. Recently, organized efforts and policies within the public sector to disseminate and implement CBT and other evidence-based psychotherapies have yielded encouraging results and provided optimism for bridging the research-to-practice-gap. Following from these efforts, the current article examines the initial impact and experience of the implementation of an individualized approach to CBT training and treatment within the Kaiser Permanente health care system. Initial training outcomes, including changes in general and specific competencies, were assessed using divergent assessment methods within the initial cohort of therapists undergoing training. Initial patient outcomes, including changes in depression and anxiety, were assessed among patients receiving treatment from therapists in training. Results revealed training in and implementation of CBT-D was associated with overall large improvements in therapist competencies and in clinically significant improvements in both depression and anxiety among patients. Findings from the initial phase of dissemination and implementation within a large private system provide support for, and extend recent findings related to, the feasibility and effectiveness of training in and implementation of CBT-D in a real-world context.     

The Role of Emotional Distress Tolerance on Fear Responding in a Heights-Fearful Sample: Perceived Versus Actual Behavior

Emotional distress tolerance (EDT)—or the ability to withstand negative emotional states—is considered a transdiagnostic risk factor for psychopathology. Although EDT is theorized to play a role in anxiety development and maintenance, research aiming to delineate the relationship between anxiety and EDT is lacking. The current study tested whether self-reported EDT predicted self-reported and actual avoidance in the presence of feared stimuli using a heights-fearful sample. Moreover, the study tested whether EDT predicted other in-the-moment fear responses, such as peak anxiety, anxious cognitions, and bodily sensations. Participants (N = 128) completed questionnaires assessing fear of heights, negative affect, anxious cognitions, and bodily sensations, as well as two heights behavioral avoidance tasks (BATs). Results demonstrated that EDT did not predict actual avoidance or other in-the-moment fear responses, except for peak anxiety in one BAT. However, EDT predicted self-reported avoidance of heights beyond fear of heights and negative affect. Taken together, results suggest that perception of ability to tolerate emotional distress predicts perception of avoidance of heights, but not actual avoidance of heights or reactions to heights (with the exception of peak anxiety in one BAT). Given these findings, self-reported EDT may not adequately predict how individuals react in anxiety-provoking situations.     

Public Attitudes on the Ethics of Deceptively Planting False Memories to Motivate Healthy Behavior

Researchers have proposed that planting false memories could have positive behavioral consequences. The idea of deceptively planting ‘beneficial’ false memories outside of the laboratory raises important ethical questions, but how might the general public appraise this moral dilemma? In two studies, participants from the USA and UK read about a fictional ‘false‐memory therapy’ that led people to adopt healthy behaviors. Participants then reported their attitudes toward the acceptability of this therapy, via scale‐rating (both studies) and open‐text (study 2) responses. The data revealed highly divergent responses to this contentious issue, ranging from abject horror to unqualified enthusiasm. Moreover, the responses shed light on conditions that participants believed would make the therapy less or more ethical. Whether or not deceptively planting memories outside the lab could ever be justifiable, these studies add valuable evidence to scientific and societal debates on neuroethics, whose relevance to memory science is increasingly acute. Copyright © 2016 The Authors Applied Cognitive Psychology Published by John Wiley & Sons Ltd.     

Improving forensic tribunal decisions: the role of the clinician

Three empirical investigations of forensic decision-making were conducted: a study of 104 hearings by a forensic tribunal; an evaluation of which aspects of forensic patients' clinical presentation were empirical predictors of violence; and a survey of forensic clinicians to determine which factors they said they used to assess risk of violent recidivism and which they actually used. Results showed a significant correlation between actuarial risk and clinical advice to the tribunal, and a nonsignificant trend for patients higher in actuarial risk to receive more restrictive dispositions. Psychotic diagnoses and symptoms were not indicators of increased risk of violent recidivism. Clinicians endorsed some empirically valid indicators of risk, but also relied on some invalid indicators. There was also inconsistency between factors clinicians said they used and factors actually related to their hypothetical decision-making. An automated system is presented as an illustration of how the consistency and validity of forensic decisions could be enhanced.     

Me, My Mobile, and I: The Role of Self- and Prototypical Identity Influences in the Prediction of Mobile Phone Behavior

This study examined the effect of and relationship between self- and prototypical identity influences on high-level mobile phone use from a theory of planned behavior (TPB) perspective. Participants were 252 university students who completed 2 questionnaires, 1 week apart. The first questionnaire assessed the standard TPB constructs (attitude, subjective norm, perceived behavioral control), as well as self- and prototypical identity influences. The second questionnaire assessed level of mobile phone use in the previous week. Support was found for the TPB in predicting high-level mobile use intentions and behavior. Self-identity and prototype similarity, but not prototype favorability, also significantly predicted intentions. The effects of prototype similarity on intentions were mediated via self-identity processes.     

An Integrative Psychological Developmental Model of Supervision for Professional School Counselors‐in‐Training

Professional school counselors (PSCs) at higher levels of psychological development negotiate complex situations and perform counselor‐related tasks with empathy, flexibility, tolerance for ambiguity, boundary setting, personal and interpersonal awareness, and self‐care more effectively than do individuals at lower levels of development. This article introduces an integrative clinical supervision model designed to promote the psychological growth (ego maturity) of PSCs‐in‐training; presents practical components of the model; and discusses implications for PSC educators, supervisors, and researchers.     

Peer Deviance,Parenting and Disruptive Behavior Among Young Girls

This study examined concurrent and longitudinal associations between peer deviance, parenting practices, and conduct and oppositional problems among young girls ages 7 and 8. Participants were 588 African American and European American girls who were part of a population-based study of the development of conduct problems and delinquency among girls. Affiliations with problem-prone peers were apparent among a sizeable minority of the girls, and these associations included both males and females. Although peer delinquency concurrently predicted disruptive behaviors, the gender of these peers did not contribute to girls’ behavior problems. Harsh parenting and low parental warmth showed both concurrent and prospective associations with girls’ disruptive behaviors. Similar patterns of association were seen for African American and European American girls. The findings show that peer and parent risk processes are important contributors to the early development of young girls’ conduct and oppositional behaviors. These data contribute to our understanding of girls’ aggression and antisocial behaviors and further inform our understanding of risk processes for these behaviors among young girls in particular.

Substance Abuse Counselors and Moral Reasoning: Hypothetical and Authentic Dilemmas

This exploratory study examined the assumption that the level of moral reasoning (Defining Issues Test; J. R. Rest, 1986) used in solving hypothetical and authentic dilemmas is similar for substance abuse counselors (N = 188). The statistical analyses used were paired‐sample t tests, Pearson product‐moment correlation, and simultaneous multiple regression. This study found that when solving dilemmas of a personal nature (authentic dilemmas), substance abuse counselors' level of moral reasoning was lower. Implications for counselor education are presented.