Clinicians' Perspectives on Negative Effects of Psychological Treatments

Negative effects of psychological treatments is a fairly unexplored area of clinical research. Previous investigations have indicated that a portion of all patients experience negative effects in terms of deterioration and various adverse events. Meanwhile, evidence suggests that many clinicians are untrained in identifying negative effects and unaware of the current research findings. The objective of the current study is thus to investigate clinicians' own perspectives and experiences of possible negative effects of psychological treatments. An invitation to participate in an anonymous online survey consisting of 14 open-ended questions was distributed via three mailing lists used by clinicians that primarily identify themselves as cognitive behavior therapists. The responses were analyzed using a qualitative method based on thematic analysis. In total, 74 participants completed the survey. A majority agreed that negative effects of psychological treatments exist and pose a problem, and many reported having experienced both deterioration and adverse events among patients in their own practice. The thematic analysis resulted in three core themes: characteristics of negative effects, causal factors, as well as methods and criteria for evaluating negative effects. The clinicians recognize that negative effects exist, but many are unaware of the current research findings and are unfamiliar with methods and criteria for identifying and preventing deterioration and adverse events. The results provide evidence for further dissemination of the present knowledge regarding negative effects, particularly during basic clinical training, as well as the need for raising awareness of the available methods for identifying and preventing negative effects.     

Downsizing in britain and its effects on survivors and their organizations

Abstract

In this paper, we examine the psychological effects of downsizing and redundancy on those remaining within organizations after large-scale redundancy programs. While there have been a number of studies of this type in the recent past, our task is to explore two separate studies which have investigated this phenomena. The first study explores the impact of redundancy in a recently privatized organization in the UK. This, we argue, is a particularly fertile area of study given the radical changes that have affected organizations in the UK that have been subjected to privatization. The results stem from an exploratory and qualitative case study which takes an individual perspective. The second study discussed in this paper explores the results of a survey conducted in the UK that examines the implications of change in both the public and private sector organizations. This survey takes a quantitative look at the implications of redundancy from an organizational perspective. By investigating these two studies, our research explores the impact of redundancy on two levels—the individual level and the organizational level. First, we examine the emotional, attitudinal and behavioral effects of redundancy on survivors and the resultant implications for management: in particular the changing role of line managers where delayering and redundancy has taken place. Second, we explore the impact of redundancy on the organization in terms of organizational morale, motivation, organizational loyalty and job security where redundancy has and has not been used as a method of downsizing.     

Analyse de la détresse psychologique de leaders narcissiques organisationnels : une étude de cas comparative

The present article is a comparative case study that explores the manifestations of psychological distress of two types of narcissistic organizational leaders. More specifically, the aim of this case study is to check for possible differences between a grandiose narcissistic leader and a vulnerable narcissistic leader in relation to three main variables associated with the manifestation of psychological distress. These variables are: trigger factors, the modulation of negative emotional reactions, the presence of early maladaptive schemas and the use of dysfunctional coping strategies. The results obtained indicate that the manifestation of psychological distress by the grandiose narcissistic leader varies in certain respects from that of the vulnerable narcissistic leader. Indeed, the psychological distress manifested by the grandiose narcissistic leader is mainly characterized by anxiety and cognitive problems. Moreover, his psychological distress appears to be accompanied by a fear of public achievement failure and the partial use of two types of dysfunctional coping strategies – self-aggrandizement with reference to ostentation and self-softening underpinned by social withdrawal. With regard to the psychological distress of the vulnerable narcissistic leader, it is essentially characterized by a profound sense of depression and irritability. Moreover, it is associated with a fear of public interpersonal rejection; the internalization of negative emotions (feelings of guilt, self-criticism and feelings of worthlessness); and the partial use of two types of dysfunctional coping strategies – self-softening underpinned by social withdrawal and self-aggrandizement with reference to ostentation.     

Change management: Time for a change!

We discuss some core issues in the field of change management. We use these topics to identify some mindsets that dominate the practice of change management, and argue that these should be replaced by some alternatives. The alternatives are drawn largely from operations management and sociotechnical thinking. We characterize existing approaches as partial, and speculate that this may be one of the reasons why so many change initiatives are ineffective at meeting their goals. We identify some of the reasons why existing mindsets are sustained. We also point to some ways forward, focusing on changes in the mindsets and language we use. We speculate that these would improve the effectiveness of change initiatives.     

The moderating effect of power distance on employee responses to psychological contract breach

Understanding how employees’ cultural values are related to their responses to promises broken by their organizations (i.e., psychological contract breach) is important given today’s global workplace. Although past research has found that psychological contract breach is positively associated with employee exit, voice and neglect and negatively associated with loyalty, we know little about the role that cultural values play in this process. We explore the role that power distance orientation—an employee’s acceptance of power differentials in society—plays in employee responses to breach. We argue that employees with high power distance orientations will be more likely to respond passively to breach (loyalty and neglect), whereas employees with low power distance orientations will be more likely to exhibit active responses to psychological contract breach (exit and voice). We tested our notions using a sample of 265 employees from different cultures across two points in time. Employees with high power distance orientations were less likely to respond to psychological contract breach with exit and voice than employees with low power distance orientations. However, power distance orientation did not significantly moderate the relationships between psychological contract breach and neglect or loyalty, respectively. We discuss theoretical and practical implications of our findings.     

An outline explanation of how therapy heals

Therapists are unable to provide a comprehensive account of therapy as an intelligible activity. This is at least partly due to the unresolved problem of explaining how phenomenology is even possible. An alternative to providing a comprehensive account of therapy is to take the fact of phenomenology for granted and provide just an outline account of how therapy heals. One way this can be achieved is to set therapy in the context of medical anthropology which will facilitate a view of therapy as just another healing ritual. Insight into how healing rituals heal is provided in this paper by a long and in-depth look at the so-called ‘paradox’ of the placebo effect. This will reveal the so-called ‘placebo effect’ as a misunderstood, modern example of healing ritual self-healing. In fact, the single term ‘placebo effect’ will be abandoned and replaced by the two concepts of ‘SMCH’ (‘specifically modified consultation and health care’) and ‘RMH’ (‘response to modified health care’). These two concepts provide an outline explanation of how all healing rituals heal and so provide an outline explanation of how the healing ritual of therapy heals, also. At least one problem arises out of explaining therapy as healing ritual self-healing, namely that this conception conflicts with the idea in therapy circles that, in therapy, it is the relationship that counts. Nonetheless, it will be maintained that the purpose of therapy is healing, that the healing that is achieved is self-healing and that its fulfilment is not dependent upon one-to-one relationships. Finally, it will be argued that the further development of therapy requires a better understanding of what aids and obstructs psycho-emotional self-healing.     

Developing physical activity interventions for youth with cystic fibrosis and congenital heart disease: Learning from their parents

Despite the benefits of physical activity for youth with cystic fibrosis (CF) and congenital heart disease (CHD), most are insufficiently active. More information is required on how to facilitate physical activity in these populations. Although there are no studies that provide information about participation in CF and CHD youth from the perspective of parents, the involvement of caregivers may be an important facilitator to physical activity in youth with chronic diseases.

Objective

This qualitative study explored how the parents of youth with CF and CHD experience physical activity, and parents commented on both their own and their child’s physical activity.

Methods

Twenty-nine parents from a CHD and CF clinic participated in a semi-structured interview, and a thematic analysis of the transcribed data was undertaken.

Results

Parents discussed the numerous benefits and barriers associated with physical activity for both child and self. Role modeling was a critical social process to overcoming barriers. Parents experiences were situated within the broader family context characterized by a prevailing sense of stress and complexity.

Conclusion

By illustrating how the parents of youth with CF and CHD understand the role of physical activity in their and their child’s life, this study provides valuable information regarding the development of interventions to increase physical activity among children with CF and CHD.     

Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process

Recent developments in CBT emphasize the promotion of psychological flexibility to improve daily functioning for people with a wide range of health conditions. In particular, one of these approaches, Acceptance and Commitment Therapy (ACT), has been studied for treatment of chronic pain. While trials have provided good support for treatment effectiveness through follow-ups of as long as seven months, the longer-term impact is not known. The present study of 108 participants with chronic pain examined outcomes three years after treatment completion and included analyses of two key treatment processes, acceptance of pain and values-based action. Overall, results indicated significant improvements in emotional and physical functioning relative to the start of treatment, as well as good maintenance of treatment gains relative to an earlier follow-up assessment. Effect size statistics were generally medium or large. At the three-year follow-up, 64.8% of patients had reliably improved in at least one key domain. Improvements in acceptance of pain and values-based action were associated with improvements in outcome measures. A “treatment responder” analysis, using variables collected at pre-treatment and shorter term follow-up, failed to identify any salient predictors of response. This study adds to the growing literature supporting the effectiveness of ACT for chronic pain and yields evidence for both statistical and clinical significance of improvements over a three-year period.     

Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed significant increases in each of the processes of psychological flexibility. Most uncontrolled effect sizes were medium or large at the follow-up. In correlation analyses changes in the four processes measures generally were significantly related to changes in the measures of depression, anxiety, and disability. In regression analyses the combined processes were related to changes in outcomes above and beyond change in pain intensity. Although in some ways preliminary, these results specifically support the unique role of general psychological acceptance in relation to improvements achieved by treatment participants. The current study clarifies potential processes of change in treatment for chronic pain, particularly those aiming to enhance psychological flexibility.     

Peripheral pain enhances the effects of incentive downshifts

Physical pain (induced by tissue damage) and psychological pain (induced by surprising incentive loss) share a set of common neural substrates, but little is known about their interactions. The present research studied such interactions using the formalin test to induce physical pain and consummatory successive negative contrast (cSNC) to induce psychological pain. In the formalin test, animals receive an intradermal injection of formalin (1%) in a hind paw. In cSNC, rats with free access to 32% sucrose show a sharp suppression of drinking behavior after a downshift to 4% sucrose, compared to rats that always receive 4% sucrose. In Experiment 1, formalin administration before the first and second 32-to-4% sucrose downshift trials enhanced cSNC. In Experiment 2, a similar treatment before the first downshift trial after a 16-to-4% sucrose downshift, which normally produces little or no evidence of cSNC, significantly increased cSNC. In Experiment 3, using a 32-to-4% sucrose downshift procedure similar to that of Experiment 1, no effects were observed following formalin administration immediately after Trial 11. Thus, no evidence was found that the effects of physical pain on cSNC were caused by changes in memory consolidation. The procedures used in these experiments offer a new approach to study the neural substrates of interactions between physical and psychological pain.