A naturalistic pilot study assessing the impact of assessment pathways and intake methods within Improving Access to Psychological Therapies services

Fast access pathways characterise many Improving Access to Psychological Therapy (IAPT) services, allowing them to see increasing numbers of referrals year on year. At the same time, emerging research is highlighting potential care inefficiencies, including early treatment disengagement, inappropriate treatment allocation, less than optimal clinical outcomes, and repeat referrals. Integrating more stratified models based on in‐depth and comprehensive assessment techniques which include some therapeutic input could help better target interventions. This could lead to improved engagement and clinical outcomes, while also providing enough therapeutic support to those attending one session only. This pilot study assesses the impact of assessment pathways and intake methods involving a 90‐min face‐to‐face therapeutic consultation, compared with a 45‐min over‐the‐phone assessment session across two IAPT providers in the south of England, and three assessment pathways involving elements of either method and service. Using an observational analysis of routinely collected data across 12 months, intake scores, attendance data and clinical measures of reliable recovery and improvement were considered. The comparisons of intake method reported no significant differences when both services were included; however, there were significant differences in treatment effect sizes and session attendance on an assessment pathway basis. Where assessment sessions were delivered, there was a higher rate of disengagement between sessions one and two, indicating increased attrition. Based on the initial findings and supporting literature, there appears to great promise in exploring pathway modelling and intake processes within IAPT services.     

Changes in the relationship between movement velocity and movement distance in primary focal hand dystonia

The authors examined the relationship between movement velocity and distance and the associated muscle activation patterns in 18 individuals with focal hand dystonia (FHD) compared with a control group of 18 individuals with no known neuromuscular condition. Participants performed targeted voluntary wrist and elbow flexion movements as fast as possible across 5 movement distances. Individuals with FHD were slower than controls across all distances, and this difference was accentuated for longer movements. Muscle activation patterns were triphasic in the majority of individuals with FHD, and muscle activation scaled with distance in a similar manner to controls. Cocontraction did not explain movement slowing in individuals with dystonia, but there was a trend toward underactivation of the 1st agonist burst in the dystonic group. The authors concluded that slowness is a consistent feature of voluntary movement in FHD and is present even in the absence of dystonic posturing. Underactivation of the 1st agonist burst appears to be the most likely reason to explain slowing.     

Understanding Gender and Culture Within the Context of Spirituality: Implications for Counselors

This article examines roles that gender, culture, and spirituality play in elements of therapeutic process. It presents an initial literature review of gender, culture, and spirituality as these factors relate to shaping identities and defining one's behavior. Discussions on how these 3 dimensions influence the level of understanding and effective responsiveness that competent counseling professionals should consider in a culturally and spiritually diverse society are presented. Three case studies provide a framework to illuminate the complexity that professionals face when counseling issues are viewed through unique gender, cultural, and spiritual worldviews. Implications for counselors and the counseling profession are provided.     

Nicotinic modulation of tone-evoked responses in auditory cortex reflects the strength of prior auditory learning

Nicotinic acetylcholine receptors (nAChRs) contribute to sensory-cognitive function, as demonstrated by evidence that nAChR activation enhances, and nAChR blockade impairs, neural processing of sensory stimuli and sensory-cognitive behavior. To better understand the relationship between nAChR function and behavior, here we compare the strength of nAChR-mediated physiology in individual animals to their prior auditory behavioral performance. Adult rats were trained on an auditory-cued, active avoidance task over 4 days and classified as “good,” “intermediate” or “poor” performers based on their initial rate of learning and eventual level of performance. Animals were then anesthetized, and tone-evoked local field potentials (LFPs) recorded in layer 4 of auditory cortex (ACx) before and after a test dose of nicotine (0.7 mg/kg, s.c.) or saline. In “good” performers, nicotine enhanced LFP amplitude and decreased response threshold to characteristic frequency (CF) stimuli, yet had opposite effects (decreased amplitude, increased threshold) on responses to spectrally distant stimuli; i.e., cortical receptive fields became more selective for CF stimuli. In contrast, nicotine had little effect on LFP amplitude in “intermediate” or “poor” performing animals. Nicotine did, however, reduce LFP onset latency in all three groups, indicating that all received an effective dose of the drug. Our findings suggest that nicotinic regulation of cortical receptive fields may be a distinguishing feature of the best-performing animals, and may facilitate sensory-related learning by enhancing receptive field selectivity.     

Simulating Memory Impairment for Child Sexual Abuse

The current study investigated effects of simulated memory impairment on recall of child sexual abuse (CSA) information. A total of 144 adults were tested for memory of a written CSA scenario in which they role-played as the victim. There were four experimental groups and two testing sessions. During Session 1, participants read a CSA story and recalled it truthfully (Genuine group), omitted CSA information (Omission group), exaggerated CSA information (Commission group), or did not recall the story at all (No Rehearsal group). One week later, at Session 2, all participants were told to recount the scenario truthfully, and their memory was then tested using free recall and cued recall questions. The Session 1 manipulation affected memory accuracy during Session 2. Specifically, compared with the Genuine group's performance, the Omission, Commission, or No Rehearsal groups' performance was characterized by increased omission and commission errors and decreased reporting of correct details. Victim blame ratings (i.e., victim responsibility and provocativeness) and participant gender predicted increased error and decreased accuracy, whereas perpetrator blame ratings predicted decreased error and increased accuracy. Findings are discussed in relation to factors that may affect memory for CSA information. Copyright © 2015 John Wiley & Sons, Ltd.