Heterogeneity of treatment changes after psychodynamic therapy within a one year follow‐up: A replication study

Naturalistic psychotherapy effect studies commonly report effect sizes for the total sample. However, a previous study of SCL‐90 Global Severity Index (GSI) improvement in a large outpatient sample used a cluster analytic strategy and reported clinical relevant outcome trajectories that could be grouped into early within‐treatment improvement, late improvement in the follow‐up period, and deteriorating patients with slight improvement that was lost at follow‐up. We explore GSI outcome trajectories and clinical significant change in a sample of 320 patients at a public psychiatric outpatient psychodynamic group therapy unit, the majority with anxiety, personality, and mood disorders. The study revealed large discharge and follow‐up effect sizes but more than one third of the patients were without measurable improvement. The major clusters described above were confirmed, and revealed unique clinical and socio‐demographic characteristics. Late improvers, as compared with early improvers, were characterized by anxiety symptoms and lack of network support after controlling for GSI at admission. Similarly, deteriorating patients had longer duration of illness and less favourable social characteristics compared with the other two groups. Early improving patients were less likely to have participated in short‐term groups, and only one third participated in additional treatment compared with more than 69% of the other patients. Severe and socially affected psychiatric patients, and patients with anxiety and agoraphobic symptoms may be less optimally treated in short‐term time limited psychodynamic groups. There is an obvious need for diversity of treatment offers, better integration of psycho‐social treatment components, and long‐term open ended treatment.     

The relationships between personality traits and one-year outcomes in patients with major depressive disorder without psychotic features

Introduction

Besides the intensity of depression, the main predictors of the outcome of a depressive episode are the comorbid disorders and certain personality traits.

Verbal instructions targeting valence alter negative conditional stimulus evaluations (but do not affect reinstatement rates)

Negative conditional stimulus (CS) valence acquired during fear conditioning may enhance fear relapse and is difficult to remove as it extinguishes slowly and does not respond to the instruction that unconditional stimulus (US) presentations will cease. We examined whether instructions targeting CS valence would be more effective. In Experiment 1, an image of one person (CS+) was paired with an aversive US, while another (CS?) was presented alone. After acquisition, participants were given positive information about the CS+ poser and negative information about the CS? poser. Instructions reversed the pattern of differential CS valence present during acquisition and eliminated differential electrodermal responding. In Experiment 2, we compared positive and negative CS revaluation by providing positive/negative information about the CS+ and neutral information about CS?. After positive revaluation, differential valence was removed and differential electrodermal responding remained intact. After negative revaluation, differential valence was strengthened and differential electrodermal responding was eliminated. Unexpectedly, the instructions did not affect the reinstatement of differential electrodermal responding.     

Is the centralization of potentially traumatic events always negative? An expansion of the Centrality of Events Scale

The autobiographical memory model of posttraumatic stress disorder (PTSD) argues that centralizing a traumatic event into one's life story is a maladaptive process associated with increased PTSD symptoms. Current measures of event centralization make no reference to whether individuals centralize the event in a positive or negative way. This study examined 400 undergraduate participants using a modified version of the Centrality of Events Scale composed of 2 factors measuring both positive and negative event centralization. Exploratory factor analysis confirmed the 2‐factor structure. Negative event centralization was associated with PTSD symptoms to a greater degree than was positive event centralization, and negative event centralization mediated the relationship between neuroticism and PTSD symptoms. Combined, these results suggest that the effect of event centralization is dependent on the valence with which the individual centralizes the event. The relationship shown between negative event centralization and PTSD symptoms supports the autobiographical memory model of PTSD.     

内隐人格观对他人知觉的影响

以大学生为被试,采用投射测验法分离出两类不同性质的内隐人格观,然后通过效价匹配实验和错觉关联实验,初步探讨了内隐人格观对他人知觉的信息加工模式的影响。研究结果表明:(1)跨性格、能力等不同人格属性有共通一致的内隐观;(2)固存观的反面就是渐变观,它们是同一维度的两极;(3)与渐变观者相比,固存观者更易以一种评价性方式知觉他人信息;同时,渐变观者不像固存观者那样对他人特质作出静态判断,而是集中注意力于理解他人行为发生的动态过程。     

The effect of cognitive reappraisal on long‐term emotional experience and emotional memory

One's ability to properly regulate emotion is critical to psychological and physical well‐being. Among various strategies to regulate emotion, cognitive reappraisal has been shown to modulate both emotional experience and emotional memory. However, most studies of reappraisal have focused on reappraisal of negative situations, with reappraisal of positive emotion receiving considerably less attention. In addition, the effects of reappraisal on emotional reactions to stimuli are typically only assessed either immediately or after a short delay, and it remains unclear whether reappraisal effects persist over longer time periods. We investigated the effect of cognitive reappraisal on emotional reactions and long‐term episodic memory for positive and negative stimuli. Men and women viewed emotionally negative, positive, and neutral pictures while they were instructed to either increase, decrease, or maintain the initial emotional reactions elicited by the pictures. Subjective ratings of emotional valence and arousal were assessed during the regulation task and again after 1 week. Memory for the pictures was assessed with free recall. Results indicated that pictures accompanied by instructions to increase emotion were better recalled than pictures reappraised to decrease emotion. Modulation of emotional arousal elicited by stimuli persisted over a week, but this effect was observed only for men. These findings suggest that cognitive reappraisal can have long‐lasting effects on emotional reactions to stimuli. However, the sex differences observed for the effects of reappraisal on emotional reactions highlight the importance of considering individual differences in the effects of regulation.     

Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age

BackgroundTo determine the effect of developmental care on neurodevelopmental outcome in formerly preterm infants at a corrected age of 2 years.MethodsA prospective phase-lag study was performed at an Austrian neonatal intensive care unit (NICU). From January 2003 to December 2005 (study period of conventional care) and January 2007 to December 2009 (study period of developmental care), we enrolled all infants born in Tyrol at less than 32 weeks of gestation. During this period a total of 261 of 359 preterm infants (participation rate 72.7%) completed the follow-up visit at 2 years of age; there were 124 children in the conventional and 137 in the developmental care group. The association between developmental care and delayed motor or mental development (Bayley Scales of Infant Development II; psychomotor or mental developmental index <85) was analyzed by means of logistic regression analysis at a corrected age of 24 months.ResultsChildren in the developmental care group showed less psychomotor delay than did those in the control group (developmental care group: 16.1%, conventional care group 27.4%; adjusted odds ratio 0.37 [95% confidence interval: 0.19–0.74], P = 0.005). Not smoking in pregnancy and higher gestational age were also significant predictors for a better psychomotor outcome at 2 years of age. Regarding cognitive outcome, no significant difference was observed between these two groups.ConclusionOur data implicate that developmental care may result in an improved 2-year psychomotor outcome in formerly preterm infants.     

Treatment Effectiveness of PMTO for Children's Behavior Problems in Iceland: Child Outcomes in a Nationwide Randomized Controlled Trial

Well‐documented treatment methods must be tested following their implementation in community service agencies and across different cultures to ensure continuing effectiveness. This study was a randomized controlled trial (RCT) of Parent Management Training—the Oregon model (PMTO), conducted within a nationwide implementation in Iceland. Families of 102 clinically referred children with behavior problems were recruited from five municipalities throughout Iceland. Child age ranged from 5 to 12; 73% were boys. Families were randomly assigned to either PMTO or services usually offered in the communities (SAU). Child adjustment was measured with a latent construct based on parent, child, and teacher reports of externalizing and internalizing problems and social skills. Prepost intent‐to‐treat analyses showed that PMTO treatment led to greater reductions in child adjustment problems relative to the comparison group, obtaining a modest to medium effect size based on the construct score. Only one indicator (parent‐rated Social Skills) showed significant change independently and information on amount and kind of treatment in the SAU was limited. Overall, findings indicate that PMTO is an effective method to treat children's behavior problems in a Northern European culture and supply evidence for the method's successful implementation in community settings in Iceland. This is one of few nationwide implementation studies of PMTO outside the United States and the first RCT in Iceland to test a treatment model for children's behavior problems.     

Feedback Informed Treatment: Evidence‐Based Practice Meets Social Construction

This article explores the challenges presented by the mandate for evidence‐based practice for family therapists who identify with the philosophical stance of social construction. The history of psychotherapy outcome research is reviewed, as are current findings that provide empirical evidence for an engaged, dialogic practice. The authors suggest that the binary between empiricism and social construction may be unhinged by understanding empiricism as a particular discursive frame (i.e., a particular way of talking, acting, and being in the world), one of many available as a way of understanding and talking about our work. Through a case vignette, the authors introduce the evidence‐based practice of Feedback Informed Treatment as an elaboration of social construction, and as an example of bridging the gap between the discursive frames of empiricism and social construction.