The Lived Experiences of Addiction Counselors After Marijuana Legalization

This qualitative study examines the perceptions of counselors who work with populations with addictions in states where marijuana has been legalized. Findings include themes related to client experiences, counselor experiences, specific interventions, and lack of understanding.     

Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.     

Conducting Prolonged Exposure for PTSD During the COVID-19 Pandemic: Considerations for Treatment

The unprecedented effects and duration of the COVID-19 crisis are likely to elevate the population’s level of anxiety due to psychological stress, economic hardship, and social isolation. This effect may be especially potent for individuals with preexisting mental health conditions, such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) therapy is a highly effective treatment for PTSD across trauma-exposed populations, and has been implemented effectively via telehealth. Nevertheless, PE implementation via telehealth may require specific adaptations during the COVID-19 crisis due to public health mandates calling for sheltering in place and physical distancing. This paper discusses strategies for implementing PE for PTSD during the COVID-19 pandemic, which may also be applied to other situations in which physical distancing must be considered.     

Comparing computer‐based training and lecture formats to teach visual analysis of baseline‐treatment graphs

Accurate analysis of data is vital to the validation of interventions. As such, there has been a recent increase in studies evaluating visual analysis training procedures. However, past investigations have not evaluated direct and indirect visual analysis training methods with matched instructional content that was systematically designed. Furthermore, training has rarely included assessment of generalization and maintenance of visual analysis skills. The purpose of the current dissertation study was to compare the effectiveness and efficiency of (a) computer‐based training, (b) lecture formats with and (c) without the opportunity to pause, and (d) a no‐training group to teach visual analysis of AB graphs to university students. To make these formats directly comparable, the instructional content was equated by ensuring information and examples were identical across the three training procedures. Eighty‐three students were randomly assigned to one of the four groups. Results showed that all three training formats produced increases in accurate responding compared to the no‐training group. Visual analysis skills generalized to novel graphs and maintained approximately 2 weeks following all trainings. These results suggest that structured approaches that are carefully designed to train visual analysis are effective and lead to gains that generalize and maintain in the absence of training.     

A preliminary evaluation of treatment duration on the resurgence of destructive behavior

Quantitative models of resurgence (e.g., Behavioral Momentum Theory, Resurgence as Choice) suggest that resurgence is partly a function of the duration of extinction exposure, with longer histories of extinction producing less resurgence. This prediction is supported by some laboratory research and has been partially supported by clinical translations that did not isolate the effects of extinction exposure prior to testing for resurgence. The degree to which different histories of extinction impact the likelihood of treatment relapse in therapeutic applications of differential reinforcement is of great interest to the clinical community, including insurance carriers and other financial providers. In the present study, we isolated the effects of extinction history for severe destructive behavior across 6 participants referred for treatment services and examined resurgence of destructive behavior when alternative reinforcement terminated. Our within-subject evaluation showed no difference in the level of resurgence or persistence of destructive behavior following short and long exposures to differential reinforcement with extinction. We discuss our failure to replicate in relation to experimental-design considerations for investigating this and other relapse phenomena in future research with clinical populations.     

A Meta-Analysis of Program Characteristics for Youth with Disruptive Behavior Problems: The Moderating Role of Program Format and Youth Gender

There is high variability in efficacy for interventions for youth with disruptive behavior problems (DBP). Despite evidence of the unique correlates and critical consequences of girls’ DBP, there is a dearth of research examining treatment efficacy for girls. This meta-analysis of 167 unique effect sizes from 29 studies (28,483 youth, 50% female; median age: 14) suggests that existing treatments have a medium positive effect on DBP (g = .33). For both boys and girls, the most effective interventions included (a) multimodal or group format, (b) cognitive skills or family systems interventions, and (c) length-intensive programs for (d) younger children. Boys demonstrated significantly greater treatment gains from group format interventions compared to girls, which is particularly important given that the group program format was the most prevalent format for boys and girls, with 14 studies involving 10,433 youth encompassing this category. This is the first meta-analysis to examine the effect of program characteristics in a sample of programs selected to be specifically inclusive of girls. Given that girls are underrepresented in intervention research on DBP, findings are discussed in terms of gender-responsive considerations and elucidating how key aspects of program structure can support more effective intervention outcomes for youth.     

骨科疾病诊治中的临床思维

医学哲学是对医学科学成就总的概括,并以此为基础探讨生命活动和病程的一般规律,研究医学科学的思维方式,直至疾病预防、诊断治疗。同时研究辩证规律和范畴在医学科学中的表现,从而指导骨科医师解决在骨科疾病诊治中遇到的诸多问题,并有助于形成正确的临床思维。结合临床工作体会,探讨医学哲学在骨科疾病诊治临床思维中的应用。     

高新技术临床应用中不合理诊疗行为的思考

高新医疗技术临床应用中的不合理诊疗行为,主要包括医方趋利性医疗行为和防御性医疗行为。通过典型案例对高新医疗技术临床应用中的不合理诊疗行为的成因进行分析,剖析不合理的诊疗行为,提出了规范应用高新医疗技术的对策。