Fault Lines in the Great EST Debate

Three fault lines traverse inquiries into empirically supported therapies, along which pro and contra positions can be taken. First, failure to distinguish scientific from artistic properties of therapy has lead to neglect of pervasive personological and cultural variables that are implicated in this field of inquiry. Second, scientific anomalies result from focusing more on what ESTs are than on how they effect change. Psyche is portrayed as a humanistic Cartesian place-holder for an encroaching neuro-endocrinological and systemic understanding of human experiencing. Third, the EST movement is seen as a socio-political and business model, confounded with and eroding scientific objectives.     

Effects of Interspersed Brief Problems on Students' Endurance at Completing Math Work

An alternating treatments design was used to compare the effects of baseline, interspersed brief problems, and interspersed brief problems plus token reinforcement on students' endurance while completing math worksheets. By pairing the completion of brief problems with token reinforcement, the role of problem completion as a conditioned reinforcer was examined consistent with the discrete task completion hypothesis. Four 5th grade students who were low achieving in math participated. Each day the students completed a stack of math worksheets containing 3-digit by 3-digit addition problems with or without interspersed single-digit problems for 10 min. Dependent measures included total digits correct per session and during each min of the 10 min work period (i.e., a measure of endurance). Results indicated that total digits correct per session was highest during the interspersal plus reinforcement condition followed by interspersal and then baseline for three of the four students. In addition, both interspersal conditions resulted in greater endurance than baseline. Limitations of the current study and implications for increasing students' persistence on classroom tasks are discussed.     

TREATING SELF-INJURY: WATER MIST SPRAY VERSUS FACIAL SCREENING OR FORCED ARM EXERCISE

In three experiments, the effect of water mist spray on self-injurious and collateral behaviors was compared with either facial screening or forced arm exercise. Water mist spray was as effective as facial screening in suppressing face-slapping in Experiment 1. However, it was not as effective as facial screening for self-injurious finger-licking in Experiment 2 or forced arm exercise for excessive ear-rubbing in Experiment 3. These results suggest that while water mist spray is effective, it may be less so than alternative procedures. In Experiments 2 and 3 there was a consistent decrease in the occurrence of untreated maladaptive behaviors. In addition, there was a moderate increase in appropriate social interaction in Experiment 2 and a substantial increase in Experiment 3.     

AN ALTERNATING TREATMENTS COMPARISON OF TWO INTENSIVE INTERVENTIONS FOR FOOD REFUSAL

We compared two treatment packages involving negative reinforcement contingencies for 3 children with chronic food refusal. One involved physically guiding the child to accept food contingent on noncompliance, whereas the other involved nonremoval of the spoon until the child accepted the presented food. Subsequent to baseline, an alternating treatments comparison was implemented in a multiple baseline design across subjects. After each child had been exposed to at least nine sessions of each treatment condition and percentage of bites accepted had increased to at least 80%, the child's caregivers selected the preferred treatment package. The results indicated that both treatments were effective in establishing food acceptance. However, physical guidance was associated with fewer corollary behaviors, shorter meal durations, and parental preference.     

Psychological science treatment

New discoveries in psychological science have changed our understanding of some basic psychological processes. The new science, however, has not of yet been properly incorporated into the practice of psychotherapy. This has created a confusing state of affairs, lacking clear distinctions between therapy interventions rooted in lore and personal insight and those based on systematic scientific inquiry. In this paper, I discuss the problems caused by the current situation and propose a new distinction by which the psychological (science) treatment of psychological disorders is differentiated from psychotherapy. The implications of the proposed distinction for clinical research and training are discussed.     

Identifying Causal Estimands for Time-Varying Treatments Measured with Time-Varying (Age or Grade-Based) Instruments

This commentary discusses causal estimands of same-age and same-grade comparisons for assessing grade-retention effects on student ability and performance. Using potential outcomes notation, we show that same-age and same-grade comparisons refer to different retention–promotion contrasts and therefore assess different causal questions. We also comment on deleting versus censoring records of students who dropped out of the study or do not belong to the treatment regimes under investigation. Whereas deleting entire student records potentially induces collider bias, censoring circumvents bias if censoring is ignorable given the observed pretreatment covariates.     

Psychometric properties of the mini-social phobia inventory (Mini-SPIN) in a large online treatment-seeking sample

The Mini-Social Phobia Inventory (Mini-SPIN) is a brief, three-item measure designed as a screening tool for social anxiety disorder (SAD). This study investigated the Mini-SPIN’s psychometric properties in a series of trials of Internet-delivered treatment. Participants were 993 people seeking Internet-delivered cognitive behavioural therapy for a range of anxiety and mood disorders. Participants completed the Mini-SPIN, and were diagnosed using the Mini International Neuropsychiatric Interview Version 5.0.0 (MINI). They also completed measures of depression, general anxiety, panic, neuroticism and general impairment. The Mini-SPIN’s ability to discriminate between people with and without SAD, within a large sample of people seeking treatment for a range of psychological disorders, was assessed at initial assessment and three-month follow-up. The Mini-SPIN’s criterion group validity, internal consistency, test–retest reliability, construct validity and responsiveness to treatment were also examined. Results demonstrated that the Mini-SPIN has an excellent ability to discriminate between those with and without SAD in a highly comorbid clinical sample, and also has good criterion group validity. The Mini-SPIN also exhibited excellent internal consistency, good test–retest reliability, and was responsive to treatment. These results highlight the Mini-SPIN’s potential as an efficient and reliable measure of SAD in heterogenous populations.     

Gender congruence and body satisfaction in nonbinary transgender people: A case control study

Abstract

Background: Binary transgender people access gender affirming medical interventions to alleviate gender incongruence and increase body satisfaction. Despite the increase in nonbinary transgender people, this population are less likely to access transgender health services compared to binary transgender people. No research has yet understood why by exploring levels of gender congruence and body satisfaction in nonbinary transgender people.

Objective: The aim of this study was to compare levels of gender congruence and body satisfaction in nonbinary transgender people to controls [binary transgender people and cisgender (nontrans) people].

Method: In total, 526 people from a community sample in the UK took part in the study (97 nonbinary, 91 binary, and 338 cisgender identifying people). Participants were asked to complete an online survey about gender congruence and body satisfaction.

Results: There were differences in gender congruence and body satisfaction between nonbinary and binary transgender people. On sex-specific parts of the body (i.e., chest, genitalia, and secondary sex characteristics), nonbinary transgender people reported significantly higher levels of gender and body satisfaction compared to binary transgender people. However, there was no difference in congruence and satisfaction with social gender role between the two transgender groups (nonbinary and binary). Cisgender people reported significantly higher levels of gender congruence and body satisfaction compared to transgender people (nonbinary and binary).

Conclusions: There are differences in gender congruence and body satisfaction between nonbinary and binary transgender people. Nonbinary individuals may be less likely to access transgender health services due to experiencing less gender incongruence and more body satisfaction compared to binary transgender people. Transgender health services need to be more inclusive of nonbinary transgender people and their support and treatment needs, which may differ from those who identify within the binary gender system.     

Empirically validated treatments—What now?

Progress in the identification of empirically supported psychological interventions is described, along with possible mechanisms for training in such treatments. Obstacles to training established clinicians, including time, cost, and geographic barriers are also discussed.     

Barriers and Facilitators to Implementing Attachment-based Family Therapy into a Child Welfare Setting: A Qualitative Process Evaluation

Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed clinical strategies to increase treatment effectiveness. Many empirically supported treatments (ESTs) exist, but little is known about EST implementation barriers and facilitators in CWS. This study explored CWS providers’ experiences of implementing attachment-based family therapy (ABFT) in home-based services of the Flemish CWS (in Belgium). Sixteen CWS providers (twelve counselors and four supervisors) involved in three home-based services were interviewed. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection, coding, and analysis of interview data. Findings revealed that implementation success was related to ABFT's fit with the CWS's mission, philosophy, and existing practices. CWS providers’ belief in the compatibility between ABFT and CWS increased investment in implementation efforts and persistence to overcome challenges and setbacks. Some barriers pertained to the learning of ABFT and some barriers pertained to systems level challenges such as lack of leadership and support, poor coordination with referral sources and other youth care partners, and lack of policy support. For successful expansion of ESTs into CWS settings, various barriers at multiple systemic levels need to be addressed.