Evaluating Supervision Models in Functional Family Therapy: Does Adding Observation Enhance Outcomes?

This study examined the effects of observation‐based supervision Building Outcomes with Observation‐Based Supervision of Therapy (BOOST therapists = 26, families = 105), versus supervision as usual (SAU therapists = 21, families = 59) on (a) youth externalizing behavior problems and (b) the moderating effects of changes in family functioning on youth externalizing behaviors for adolescents receiving Functional Family Therapy (FFT). Exploratory analyses examined the impact of supervision conditions on youth internalizing problems. In 8 community agencies, experienced FFT therapists (M = 1.4 years) received either BOOST or SAU supervision in a quasi‐experimental design. Male (59%) or female (41%) adolescents were referred for the treatment of behavior problems (e.g., delinquency, substance use). Clients were Hispanic (62%), African American (19%), Non‐Hispanic White (12%), or Other (7%) ethnic/racial origins. Therapists (female, 77%) were Hispanic 45%, African American (19%), White Non‐Hispanic (30%), or other (4%) ethnic/racial backgrounds. Analyses controlled for the presence or absence of clinically elevated symptoms on outcome variables. Clinical outcomes were measured at baseline, 5 months, and 12 months after treatment initiation. Clients with externalizing behavior above clinical thresholds had significantly greater reductions in problem behaviors in the BOOST versus the SAU conditions. Clients below thresholds did not respond differentially to conditions. Supervisors in BOOST had more experience with the FFT model; as such, the observed results may be a result of supervisor experience. The BOOST supervision was associated with improved outcomes on problem behaviors that were above clinical thresholds. The findings demonstrate the importance of addressing client case mix in implementation studies in natural environments.     

Do Parents’ Adverse Childhood Experiences Influence Treatment Responses to Parent-Child Interaction Therapy? An exploratory Study with a Child Welfare Sample

This exploratory study of 23 parent–child dyads receiving child welfare services examined the association between the number of adverse childhood experiences (ACEs) parents reported and their children’s externalizing behaviors. We also assessed whether the effects of Parent-Child Interaction Therapy (PCIT) on externalizing behaviors varied by parents’ ACE histories. Results indicated that parents’ ACE scores were associated with child externalizing symptoms at baseline, but not at a second postbaseline assessment. Although all parents reported reductions in child externalizing behavior from baseline to postbaseline, only reductions reported by parents with four or more ACEs were statistically significant. Implications for implementing PCIT with trauma-exposed families are discussed.     

The Concept of Psychological Health in Rational Emotive Behavior Therapy

The argument has been made that if Rational Emotive Behavior Therapy (REBT) is to survive and prosper in the 21st century, its underlying personality theory requires further development and clarification. In this spirit, the concept of psychological health in REBT theory is examined in the present article. The concept of psychological health in personality theories is discussed briefly, as are the core aspects of the REBT view of emotional disturbance. Given that necessary context, a definition of the essence of psychological health in REBT theory is proposed and discussed. The clinical implications of the proposed definition are then explored.     

A pragmatic approach to measuring adherence in treatment delivery in psychotherapy

ABSTRACT

Measuring therapists’ adherence to treatment manuals is recommended for evaluating treatment integrity, yet ways to do this are poorly defined, time consuming, and costly. The aims of the study were to develop a Therapy Component Checklist (TCC) to measure adherence to manualised CBT; to test its application in research and clinical practice; to determine its validity; and consider its cost benefits. We conducted a randomised trial in 230 people with cancer evaluating effectiveness of CBT for depression. In this, therapists delivered manualised treatment. Experts agreed on key components of therapy and therapists were asked to record these after therapy sessions by ticking a TCC. Inter-rater reliability was tested using an independent rater. Therapists delivered 543 CBT sessions. TCCs were completed in 293, of which 39 were assessed by the independent rater. Self-reported TCC data suggested close adherence to the manual. Prevalence-adjusted and bias-adjusted kappa scores suggested substantial agreement, (>0.60) in 38 out of 46 items. Self-rating of adherence saved around £96 per rating. In conclusion the TCC provides a quick and cost effective way of evaluating the components of therapy delivered. This approach could be applied to other psychological treatments and may help with linking therapeutic interventions with outcome.     

Implicit associations between anxiety-related symptoms and catastrophic consequences in high anxiety sensitive individuals

Anxiety sensitivity refers to the fear of anxiety-related physical sensations arising from beliefs that these sensations have harmful consequences (Reiss & McNally, 1985). The present study examined whether individuals with high (vs. low) anxiety sensitivity show stronger implicit associations in memory between anxiety-related symptoms, as opposed to neutral body parts, and harmful, as compared to harmless, consequences. A total of 22 undergraduate students (14 F, 8 M) completed the Extrinsic Affective Simon Task (EAST; De Houwer, 2003). Results indicated that high anxiety sensitive individuals (n = 10) tended to implicitly associate harmful consequences with anxiety-related symptoms. Their performance was significantly faster on trials where target words related to anxiety symptoms were mapped on to the same response key as harmful consequences. No significant difference in performance was found for low anxiety sensitive individuals (n = 12) or when target words were body parts unlikely related to diseases. Between-group differences persisted after controlling for trait anxiety and history of panic attacks, but not when illness-related beliefs were introduced as a covariate. Identifying this implicit association bias provides additional empirical support for the concept of anxiety sensitivity.     

单克隆抗体的治病与“致病”

对单克隆抗体在病毒性疾病治疗和引起病毒感染增强两方面的作用进行了综述，分析了各自涉及的机理。指出于者是矛盾的统一体，辨证地看待是前提，深入研究是关键，合理和才是目标。     

Using targeted visceroception to improve interoceptive sensibility and emotion regulation

Focusing on one's body can improve the awareness and regulation of emotion. Interoception – sensing the physiological condition of the body, particularly of the viscera – appears to play an important role. While the majority of previous research studies have examined interoceptive sensitivity (i.e., detection of objectively measurable physiological changes), there has been relatively limited investigation of interoceptive sensibility (i.e., subjective awareness of those changes), and even fewer studies permitting causal conclusions. The current study is part of a randomised controlled trial on visceroception in the context of emotion regulation, using an 8-week intervention involving focused attention on either cardiac or gastrointestinal activity. Group differences in emotion regulation and reactivity were assessed using the Multidimensional Assessment of Interoceptive Awareness (MAIA), the Difficulties in Emotion Regulation Scale, and the Emotion Reactivity Scale (ERS). The findings suggest that focussed attention on gastrointestinal activity (i.e., gastroception), in particular, improves interoceptive sensibility and emotion regulation, as evidenced by increases on the MAIA's Noticing, Body Listening, and Self-regulation subscales, and decreases on the Arousal subscale of the ERS. Gastroception may make distinct contributions to the benefits of body focus in a research context where the gut is often overlooked.     

ON AGGRESSION TURNED AGAINST THE SELF

Deliberate self‐harm is a common presenting problem suffered by young people. Several patients referred to the NHS outpatient clinic where I work have been able to stop harming themselves during intensive psychoanalytic psychotherapy. In this paper, I shall discuss a variety of motives for persistent cutting by one adolescent girl. I am most interested to show how the healthier part of her personality overcame her motives for harming herself, and eventually allowed her to make use of my understanding of a sadomasochistic internal object that worked against us.