希望思维在临床与实践领域的应用、特点与启示

摘 要 自Snyder提出以来,希望思维的认知理论已经发展了20余年,它在世界各地的不同领域都得到了广泛认可,将其应用于临床领域则成为近年来的热点。大量研究表明系统的训练可以促使希望思维产生和提高,从而帮助个体改善生理疾病和心理疾病,矫正不良行为。与此同时,希望思维能够用于帮助个体更好地应对压力情景,促进积极心理健康,帮助其更好的成长。总的来说,希望思维的临床应用具有适用范围广泛、干预方法相对简单易行、可以作为独立的希望干预系统和也能与传统心理治疗相融合四个特点。未来对希望思维在临床领域的应用与研究一方面要注重对新的本土化的干预策略的开发,另一方面要注重对其内部作用机制的研究和应用。     

A systematic review and meta‐analysis of tertiary interventions in clinical burnout

Clinical burnout is one of the leading causes of work absenteeism in high‐ and middle‐income countries. There is hence a great need for the identification of effective intervention strategies to increase return‐to‐work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non‐randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random‐effects meta‐analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait‐list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15–9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59–2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers.     

Reflecting on self-care practices during clinical psychology training and beyond

In this paper, I will discuss the concept of self-care and its importance for clinical psychologists, both during training and post-qualification. I will review the pertinent literature in this area covering the concept of self-care and its meaning, the personal and professional impact of a lack of self-care for clinical psychologists, and discuss some of the barriers to implementing self-care practices. Throughout the discussion of barriers to self-care, I will intersperse three reflective pieces on my own experiences throughout clinical psychology training, which will allow for a more in-depth exploration of the issues. My conclusion will highlight the personal, professional and systemic barriers to self-care in clinical psychologists, and in other helping professionals, and suggest possible ways of tackling these barriers and promoting greater utilisation of self-care during clinical training and beyond and across different professional groups.     

Medical Psychology Services in Dutch General Hospitals: State of the Art Developments and Recommendations for the Future

In this article an overview is presented of the emergence of medical psychology in the care of somatically ill patients. The situation in the Netherlands can be considered as prototypical. For 60 years, clinical psychologists have been working in general, teaching and academic hospitals. Nowadays, they are an integrated non-medical specialism working in the medical setting of hospitals in the Netherlands, and are a full-member of the medical board. This paper discusses several topics: the position of the general hospital in the health care system in the Netherlands, the emergence of medical psychology in Dutch hospitals, the role of the professional association of medical psychologists, and the characteristics of patients seen by clinical psychologists. Following the discussion about the situation of medical psychology in other countries, recommendations are formulated for the further development of medical psychology in the Netherlands as well as in other countries.     

The value of RCT evidence depends on the quality of statistical analysis

The authors examined statistical practices in 193 randomized controlled trials (RCTs) of psychological therapies published in prominent psychology and psychiatry journals during 1999-2003. Statistical significance tests were used in 99% of RCTs, 84% discussed clinical significance, but only 46% considered-even minimally-statistical power, 31% interpreted effect size and only 2% interpreted confidence intervals. In a second study, 42 respondents to an email survey of the authors of RCTs analyzed in the first study indicated they consider it very important to know the magnitude and clinical importance of the effect, in addition to whether a treatment effect exists. The present authors conclude that published RCTs focus on statistical significance tests ("Is there an effect or difference?"), and neglect other important questions: "How large is the effect?" and "Is the effect clinically important?" They advocate improved statistical reporting of RCTs especially by reporting and interpreting clinical significance, effect sizes and confidence intervals.     

Value of interviews for admission to clinical training programs: Perspective of program directors

Abstract: The interview has a long history of being used to select individuals for positions in industry, professional occupations, and for a variety of specialised educational programs. Despite its widespread popularity, the selection interview is often criticised for its potential bias and unreliability, which in turn has led to its decreasing use in some settings. The purpose of the present study was to explore the views of the directors of 21 Australian clinical training programs as to the value of interviews as part of the admission process for their clinical psychology postgraduate training candidates. Three programs reported not conducting interviews at all, expressing reservations concerning their validity. Most other directors saw interviews as having at least some value, with the opportunity to evaluate interpersonal skills being one of the most commonly mentioned advantages. A variety of methods was used for the final admission decisions, with substantial variation in acceptance rates by candidates who survived the interview process. Implications for selection processes in the future are discussed.     

Focus on clinical psychology postgraduate training: Taking the curriculum into the next decade

Abstract: Clinical psychology, like many applied disciplines, often suffers from a lack of congruence between best‐practice in terms of pedagogy and evidence‐based practice and the actual structure and content of training programs. A small but growing international literature addresses such issues. A small group of researchers from five Australian Universities, led by a team at the University of Queensland, has received grant money over two years to examine and offer constructive strategies for revising and revitalising the clinical psychology training curriculum in Australia, with reference to international pedagogy and training standards.     

Caregiver Involvement in the Intensive Mental Health Program: Influence on Changes in Child Functioning

We examined behavioral markers of caregiver involvement and the ways in which family participation was related to treatment outcomes in 47 elementary school children with SED enrolled in a school-based intensive mental health program. Measures of caregiver involvement included therapeutic home visits, attendance at therapeutic meetings, completion of ratings on the daily point sheet, and extra communications with the therapeutic team on the point sheet. Greater initial impairment was associated with greater caregiver involvement. Greater caregiver involvement was linked to improvement in child thought processes, increased ability to provide emotional and social supports for the child, and greater overall child functioning at discharge. Our findings also reflected increased therapists’ attempts to provide additional in-home services in cases where caregivers demonstrated a decline in their ability to provide for their children’s physical and material needs, or in which therapists discovered that the family functioning was more impaired than what was initially assessed. We provide a case study that exemplifies many of these findings.     

Advancing Psychology as a Bio-behavioral Science

Concerns for the integrity of psychology as an independent discipline have caused some psychologists to object to introducing any knowledge from the biological sciences into the training of psychologists. However, calls for the greater incorporation of the behavioral sciences in medical education, increased attention to research on the mechanisms of bio-behavioral interaction, and initiatives in translational medical research and clinical care, have prompted increased interest in interdisciplinary research, health care, and teaching. These changes, in turn, are resulting in a re-conceptualization of the structure of academic medicine with increasing emphasis upon multidisciplinary knowledge and interdisciplinary collaboration, and less emphasis upon disciplinary insularity and competitiveness. If clinical health psychology is to play a role in this evolving concept of academic health care, it must adequately prepare its trainees to function in interdisciplinary academic health care settings. This will require not only expertise in the role of behavioral factors relevant to medical disorders, but also some basic familiarity with the biological processes to which those behavioral factors relate. With the evolution of its fund of knowledge, clinical health psychology has the potential to utilize its science to discover, describe, interpret, teach and clinically apply knowledge of the mechanisms of interaction between biological functions and behavioral, learning, cognitive, socio-cultural and environmental processes. By failing to seize this initiative, clinical health psychology risks becoming irrelevant to the evolving model of medical research, education and health care. Presented, in part, to the Association of Psychologists in Academic Health Centers, Minneapolis, MN, May 2007.