The being a patient effect: negative expectations based on group labeling and corresponding treatment affect patient performance

Patient studies provide insights into mechanisms underlying diseases and thus represent a cornerstone of clinical research. In this study, we report evidence that differences between patients and controls might partly be based on expectations generated by the patients’ knowledge of being invited and treated as a patient: the Being a Patient effect (BP effect). This finding extends previous neuropsychological reports on diagnosis threat. Participants with mild allergies were addressed either as patients or control subjects in a clinical study. We measured the impact of this group labeling and corresponding instructions on pain perception and cognitive performance. Our results provide evidence that the BP effect can indeed affect physiological and cognitive measures in clinical settings. Importantly, these effects can lead to systematic overestimation of genuine disease effects and should be taken into account when disease effects are investigated. Finally, we propose strategies to avoid or minimize this critical confound.     

“Part of me feels like there must be something missing”: a phenomenological exploration of practising psychotherapy as a clinical psychologist

The experience of practising psychotherapy as a clinical psychologist was explored through a small number of in-depth interviews. Using Interpretative Phenomenological Analysis, three main themes were identified: “Feeling there’s something missing”, “Being able to get in there emotionally” and “Needing somewhere to go for support”. This study suggests that training for psychotherapy work can be experienced as piecemeal and fragmented, contributing to professional self-doubt, with clinical psychologists seeking more structured, cohesive training in this area. It also suggests that engagement in personal therapy can contribute to greater emotional capacity as a psychotherapy practitioner, although clinical psychologists can fear engaging in something that is unfamiliar. In addition, the psychologists highlighted the felt necessity of safe and satisfying supervision for resilient practice.     

An Evaluation of Pharmacological Treatment Combined with Stress Inoculation Training in the Management of oral Lichen Planus

The aim of this pilot study was to examine the effects of the inclusion of a cognitive-behavioral intervention to the pharmacological treatment of oral lichen planus (OLP). Using a randomized controlled clinical trial, 16 patients affected by OLP were treated either with a potent corticosteroid in addition with stress inoculation training or with the drug alone. There were significant differences between the groups regarding the severity of the pathology both at the end of the treatment as well as at one-month follow-up. It is concluded that a cognitive-behavioral intervention might be usefully combined with pharmacological treatment for OLP.     

In-Home Parent-Child Interaction Therapy: Clinical Considerations

ABSTRACT

Parent-Child Interaction Therapy (PCIT) is an empirically-supported behavioral parent training program designed to be administered in a clinic or laboratory-based setting. Recently, an empirical investigation revealed that in-home PCIT produced comparable results as the PCIT trials conducted in more controlled environments (this issue). Administering PCIT in a home setting carries both drawbacks and advantages. This article provides an overview of both the positive and negative clinical aspects of conducting in-home PCIT and presents effective solutions to potential treatment barriers.     

A Longitudinal Study of Factors Influencing Occupational Therapy Students' Practice Preference from Pre-Admission Through Job Selection

Abstract

The number of occupational therapists and students choosing to practice in the area of mental health continues to decline. A longitudinal comparative study was conducted using a class of 27 Bachelor's and 20 Master's students, to examine the factors that influence the students' practice area preference at three points from pre-admission to job selection. The major influential factors were similar for both groups. At pre-admission, observation, volunteer work or a job in OT or a related field was reported to be the most influential factor in choosing a practice area preference. At level II fieldwork, positive influences on practice area preference were generally higher for physical disabilities, and negative influences were higher for mental health. At job selection, availability of a job and patient population were the most important influencing factors. Pre-admission experiences, level II fieldwork, and professionally challenging aspects of the practice area preference were the most important retrospective experiences influencing preference for practice area. In order to maintain or increase a presence in mental health the profession may need to expand OT students' pre-admission experiential expectations, professional mental health supports, and job opportunities in mental health.     

Reprint of: technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.     

Analysis of the multidimensionality of hallucination-like experiences in clinical and nonclinical Spanish samples and their relation to clinical symptoms: implications for the model of continuity

Numerous studies have found that hallucinatory experiences occur in the general population. But to date, few studies have been conducted to compare clinical and nonclinical groups across a broad array of clinical symptoms that may co-occur with hallucinations. Likewise, hallucination-like experiences are measured as a multidimensional construct, with clinical and subclinical components related to vivid daydreams, intrusive thoughts, perceptual disturbance, and clinical hallucinatory experiences. Nevertheless, these individual subcomponents have not been examined across a broad spectrum of clinically disordered and nonclinical groups. The goal of the present study was to analyze the differences and similarities in the distribution of responses to hallucination-like experience in clinical and nonclinical populations and to determine the relation of these hallucination-like experiences with various clinical symptoms. These groups included patients with schizophrenia, non-psychotic clinically disordered patients, and a group of individuals with no psychiatric diagnoses. The results revealed that hallucination-like experiences are related to various clinical symptoms across diverse groups of individuals. Regression analysis found that the Psychoticism dimension of the Symptom Check List (SCL-90-R) was the most important predictor of hallucination-like experiences. Additionally, increased auditory and visual hallucination was the only subcomponent that differentiated schizophrenic patients from other groups. This distribution of responses in the dimensions of hallucination-like experiences suggests that not all the dimensions are characteristic of people hearing voices. Vivid daydreams, intrusive thoughts, and auditory distortions and visual perceptual distortions may represent a state of general vulnerability that does not denote a specific risk for clinical hallucinations. Overall, these results support the notion that hallucination-like experiences are closer to a quasi-continuum approach and that total scores on these scales explain a state of vulnerability to general perceptual disturbance.     

Depressive realism and clinical depression

Depressive realism suggests that depressed individuals make more accurate judgments of control than their nondepressed counterparts. However, most studies demonstrating this phenomenon were conducted in nonclinical samples. In this study, psychiatric patients who met criteria for major depressive disorder underestimated control in a contingent situation and were consistently more negative in their judgments than were nondepressed controls. Depressed patients were less likely than their nondepressed counterparts to overestimate control in a noncontingent situation, but largely because they perceived receiving less reinforcement. Depressed patients were no more likely to use the appropriate logical heuristic to generate their judgments of control than their nondepressed counterparts and each appeared to rely on different primitive heuristics. Depressed patients were consistently more negative than their nondepressed counterparts and when they did appear to be more “accurate” in their judgments of control (as in the noncontingent situation) it was largely because they applied the wrong heuristic to less accurate information. These findings do not support the notion of depressive realism and suggest that depressed patients distort their judgments in a characteristically negative fashion.     

The phenomenon of vulnerability in clinical encounters

After a brief, personal reflection on Aron Gurwitsch’s life and his many influences on my career, I devote this lecture to some of the central themes of a phenomenology of medicine. Its core is the clinical encounter, which displays a certain structure I term the asymmetry of power (physician) and vulnerability (patient, family)—a complex contextual imbalance characterized by multiple points of view, hence points for reflective entrance. These are then interpreted phenomenologically in terms of epoché and reduction (practical distantiation), evidence, reflection, and other related themes. I conclude with a suggestion about “the fundamental method” of phenomenology, free fantasy variation. This paper was delivered as The Aron Gurwitsch Memorial Lecture, October 21, 2005, co-sponsored by The Center for Advanced Research in Phenomenology and the Society for Phenomenology and Existential Philosophy, Salt Lake City, Utah. It is based on a number of articles, chapters and books I have written over the past several decades (see especially 2000, pp. 123–140; 1995b, pp. 147–168).