Cognitive factors influence outcome following multidisciplinary chronic pain treatment: a replication and extension of a cross-lagged panel analysis

Reducing maladaptive cognitions is hypothesized to constitute an active therapeutic process in multidisciplinary pain programs featuring cognitive-behavioral interventions. A cross-lagged panel design was used to determine whether: a) early-treatment cognitive changes predicted late-treatment pain, interference, activity and mood changes, but not vice versa; b) three cognitive factors made unique contributions to outcome; c) substantial cognitive changes preceded substantial improvements in outcome. Sixty-five chronic pain patients, participating in a 4-week multidisciplinary program, completed measures of pain helplessness, catastrophizing, pain-related anxiety (process factors), pain severity, interference, activity level and depression (outcomes) at pre-, mid- and posttreatment. Results showed that early-treatment reductions in pain helplessness predicted late-treatment decreases in pain and interference, but not vice versa, and that early-treatment reductions in catastrophizing and pain-related anxiety predicted late-treatment improvements in pain severity, but not vice versa. Findings suggested that the three process factors predicted improvements mostly in common. However, little evidence was found that large early-treatment reductions in process variables preceded extensive improvements in pain. Findings replicate those of a recent report regarding cross-lagged effects, and offer support that cognitive changes may indeed influence late-treatment changes in outcomes.     

In defence of loose ends: Psychotherapy process research in the real world

Understanding what transpires in therapeutic conversations is as complex as the humans who are engaged in them. Inspired by the natural sciences, mainstream research in psychotherapy has taken up a positivist epistemology and strives for quantification and verification to produce evidence of the effectiveness of an approach. This paper explores an alternative foundation for therapeutic practices which has implications for how we do research. First, we present some ideas from process philosophy and dialogical perspectives.. In particular we return to the ideas of Henri Bergson who understood change as consisting of interpenetrated continuous and shifting states. In a next step we briefly look into how such ideas have influenced what is referred to as dialogical practices. Such dialogical practices operate through facilitating polyphonic, diverse perspectives that may mediate change in and through an intersubjective process of becoming. Based on this we take another step and make some suggestions for how we may develop research that enables ways of exploring therapeutic conversations as a multi-voiced, interactional and unfinalized process. We offer by way of example a method by which we attempt to integrate a linguistic theory (Systemic functional linguistics) with the dialogical framework and the ideas of Bergson. This paper considers how process philosophy may offer an alternative to the seeking of certainty that occurs in both psychotherapy research and practice, and ideas for making space for the ‘loose ends’ of the inconsistent and the unknown.     

What is the process of personal growth? Introducing the Personal Growth Process Model

Personal growth as a process remains vaguely understood. We introduce the Personal Growth Process (PGP) model based on Carl Rogers's organismic valuing process (OVP). The PGP model explains personal growth as a sociocognitive embodied process whereby an individual undergoes multiple mental shifts that make up an ongoing, fluctuating process over the long term, starting from a place of psychological safety. The mental shifts occurring throughout the growth process are broadly categorized as self-awareness, openness towards experiencing and change, existential courage, autonomy/internal locus of control, taking responsibility for the self and others, self-compassion, and compassion towards others. These shifts all represent progress toward well-being, defined here as authenticity, harmony and life-satisfaction. Importantly, the model does not include only individual psychological constructs, but ties the process to one's social environment and common social responsibility.     

Caveats on a process-tracing measure and a remedy

In process-tracing studies, a frequently used index describes whether information selection behavior is attribute — or alternativewise. The performance of this index is investigated under the assumption that subjects select information in a random fashion. The results show that the index may lead to inaccurate conclusions regarding the information-acquisition strategy of a subject. In addition, a Monte Carlo study is conducted that examines the sensitivity of the index to strategy changes. An alternative index is derived and a latent-class model is proposed for a parsimonious representation of individual differences in information acquisition.     

Behavioral contrast and generalization across settings in the treatment of autistic children

Previous research on the generalization of treatment gains across settings has typically focused on the question of whether generalization occurs or does not occur. However, the experimental literature suggests another possibility: that behavioral contrast may occur in extra-therapy settings if the reinforcement procedures in the therapy setting are highly discriminable from those in other settings. Therefore, this investigation was designed to systematically assess whether: (1) a highly discriminable treatment procedure in one setting would produce a behavioral contrast effect in other unmanipulated settings; and (2) such contrast-like trends could be eliminated if initially different reinforcement procedures in two settings were subsequently made similar. The results for the eight autistic children who participated in this investigation showed that: (1) When very different reinforcement procedures (primary rewards or punishment in therapy settings, and no rewards or punishment in extra-therapy settings) were in effect, the children showed contrast-like behavior changes in the untreated extra-therapy settings; and (2) such trends in responding could be eliminated, resulting in generalization of treatment gains, if the reinforcement procedures were subsequently made relatively similar in the two settings, even if the procedures consisted essentially of noncontingent reinforcement.     

The influence of task variation and maintenance tasks on the learning and affect of autistic children

Analyses of autistic children's learning and affect have begun to consider the role of antecedent variables, including the manner with which tasks are sequenced within instructional sessions. Within the context of a simultaneous-treatments design, this experiment evaluated autistic children's affect and rate of task acquisition under three experimental conditions. The conditions were (1) a constant task condition in which only one acquisition task was presented per session; (2) a varied-acquisition-task condition, in which 10 acquisition tasks were randomly interspersed throughout each session; and (3) a varied-with-maintenance-task condition, which randomly interspersed 5 acquisition tasks and 5 which had been previously acquired. The results showed significantly more efficient learning under the varied-maintenance condition, with no consistent differences separating the other two conditions. In addition, observers' ratings of the children's affect showed that the most positive judgments were produced by the varied-maintenance condition. The varied-acquisition condition was next while the constant task condition always produced the least favorable ratings. These findings are discussed in relation to the literature on massed versus distributed practice, stimulus variation, and success-induced motivation. The implications for upgrading the treatment and education of handicapped children are also reviewed.     

Teaching autistic children to respond to simultaneous multiple cues

A number of studies have shown that autistic children tend to learn new discriminations by responding to only a restricted number of available cues and that this may be responsible for some of their abnormal behavior. Therefore, this investigation assessed the feasibility of teaching autistic children to respond to multiple cues. The results showed that four autistic children could learn a conditional discrimination requiring them to discriminate a multiple-cue complex from each of its two component cues. However, the autistic children did not learn this discrimination in the same manner as normal children. In the early trials, the autistics responded at a higher level to one of the two component cues. Only after many trials did the autistics respond equally on the basis of both component cues. The results of an initial attempt to teach a general set to respond to multiple cues showed that, when an autistic child was taught a series of successive conditional discriminations, the child eventually learned a set to approach new discriminations by responding equally on the basis of both component cues. The results are discussed in terms of understanding and treating autistic children's abnormal development.     

Sequencing actions: an information-search study of tradeoffs of priorities against spatiotemporal constraints

How people choose between sequences of actions was investigated in an everyday errandplanning task. In this task subjects chose the preferred sequence of performing a number of errands in a fictitious environment. Two experiments were conducted with undergraduate students serving as subjects. One group searched information about each alternative. The same information was directly available to another group. In Experiment 1 the results showed that for two errands subjects took into account all attributes describing the errands, thus suggesting a tradeoff between priority, wait time, and travel distance with priority being the most important. Consistent with this finding predominantly intraalternative information search was observed. These results were replicated in Experiment 2 for three errands. In addition choice outcomes, information search, and sequence of responding suggested that for more than two actions sequence choices are made in stages.     

The Discursive Performance of Change Process in Systemic and Constructionist Therapies: A Systematic Meta‐Synthesis Review of In‐Session Therapy Discourse

Despite the emphasis of systemic and constructionist approaches on discourse and interaction, to date there has been no comprehensive overview of how change process is performed within in‐session therapeutic dialogue. In this paper, we present a qualitative meta‐synthesis of 35 articles reporting systemic and constructionist therapy process data from naturally occurring therapeutic dialogue. The studies were selected following the screening against eligibility criteria of a total sample of 2,977 studies identified through a systematic search of PsycINFO and MEDLINE databases. Thematic analysis of the 35 studies’ findings identified four main themes depicting change process performance: (a) shifting to a relational perspective, (b) shifting to non‐pathologizing therapeutic dialogue, (c) moving‐forward dialogue, and (d) the dialogic interplay of power. Findings highlight the interactional and discursive matrix within which systemic and constructionist change process occurs. Findings illuminate the value of qualitative research studies sampling naturally occurring therapeutic discourse in bringing this matrix forth, particularly when utilizing discursive methodologies like conversation or discourse analysis.     

Signs and the process of interpretation: sign as an object and as a process

Historically the words representation and symbol have had overlapping meanings, meanings that usually disregard the role played by the interpreter. Peirce’s theory of signs accounts for these meanings and also for the role of the interpreter. His theory draws attention to the static and dynamic nature of signs. Sign interpretation can be viewed as a continuous dynamic and evolving process. The static and dynamic nature of signs helps us understand the teaching–learning activity as a process of interpretation on the part of teacher and students. The paper attempts to explain the classroom interpretation process on the part of the actors involved using the Peircean theory of signs.