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.     

Reliability, diagnostic efficiency, and validity of the Millon adolescent clinical inventory: examination of selected scales in psychiatrically hospitalized adolescents

This study examined the internal consistency, diagnostic efficiency, and validity of selected scales of the Millon adolescent clinical inventory (MACI; Millon et al., Manual for the Millon Adolescent Clinical Inventory, National Computer Systems, Minneapolis, MN, 1993). 241 psychiatrically hospitalized adolescents were administered the MACI and a battery of established self-report measures and a multidisciplinary team independently assigned DSM-IV psychiatric diagnoses at the time of discharge. The internal consistency of MACI scales ranged from 0.71 to 0.93. Conditional probabilities (sensitivity, specificity, positive predictive power, and negative predictive power) were calculated for selected disorders using independently generated clinical diagnoses as the standard. The diagnostic efficiencies for the selected scales were variable, with adequate performance for predicting classes of diagnoses but not for specific diagnoses. The MACI showed good criterion validity for most disorders, with participants with a clinical diagnosis having a significantly higher corresponding MACI scale score than participants not assigned that diagnosis. Concurrent validity, tested by correlating MACI scale scores with those of relevant, validated measures, was generally good. The MACI appears to be a psychometrically sound self-report instrument and appears valuable as a screening instrument for many problems found in adolescent psychiatric inpatients.     

Idiographic outcome analyses of the clinical significance of two interventions for patients with musculoskeletal pain

This study adopted a perspective of the individual to define domains of everyday life for the analysis of clinically meaningful change. The purpose was to compare the clinical significance of two interventions for patients with musculoskeletal pain, applying an idiographic outcome measure, The Patient Goal Priority Questionnaire, in combination with the Jacobson and Truax methodology [(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 67 (3), 300-307] for determination of clinical significance. The concurrent validity of the outcome variables behavioral performance, satisfaction with behavioral performance, and fulfilled pre-treatment expectations was also studied. Eighty-two patients, randomized to either individually tailored behavioral medicine treatment (experimental group) or physical exercise therapy (control group) were evaluated at baseline and 3 months post-treatment regarding behavioral treatment goals. The experimental intervention had high impact on participants' performance of their highest ranked everyday life activities, and resulted in larger proportions of clinically significant outcomes compared with controls. The concurrent validity of the outcomes was high for those reporting clinically significant changes, but more generally, there was a moderate agreement across outcome categories. The individual should be the unit for analyses of clinical significance to enhance the ecological validity of the construct. Further development of idiographic outcome measures is necessary, as is the inclusion in pain intervention research.     

Effectiveness of an empirically supported treatment for social phobia in the field

This study examined the effectiveness of individual exposure combined with cognitive restructuring for social phobia in a clinical setting as well as the influence of sample restriction criteria on the effect size. Participants were 217 unselected patients with a primary diagnosis of social phobia who were treated by 57 therapists in four outpatient clinics of the Christoph-Dornier-Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy showed highly significant reductions in social phobic fears and avoidance as well as in general anxiety and symptoms of depression. However, patients who dropped out during therapy reported a significantly higher degree of depression. Results did not differ between the four outpatient clinics and are comparable with the average effect-sizes reported by meta-analytic studies of controlled efficacy research, using selected patients. Also, restricting the sample according to the selection criteria often applied in research settings did not result in higher effect sizes for the applied outcome measures. We conclude that individual cognitive behavioural therapy for social phobia can be transported from research settings to the field of mental health.     

How effective are cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis

Controlled outcome studies investigating the efficacy of psychological treatments for obsessive-compulsive disorder (OCD) have employed different methods of determining the clinical significance of treatment effects. This makes it difficult to draw conclusions regarding the absolute and relative efficacy of psychological treatments for OCD. To address this issue, standardized Jacobson methodology for defining clinically significant change was applied to recent psychological outcome trials for OCD. The proportion of asymptomatic patients following treatment was also calculated. When recovery is defined by Jacobson methodology, exposure and response prevention (ERP) appears the most effective treatment currently available (50-60% recovered). However, when the asymptomatic criterion is used as the index of outcome, ERP and cognitive therapy have low and equivalent recovery rates (approximately 25%).     

The effects of safety-seeking behavior and guided threat reappraisal on fear reduction during exposure: an experimental investigation

We examined the effects of safety-seeking behavior and guided threat focus and reappraisal on fear reduction during exposure. Participants (N=46) displaying marked claustrophobic fear were randomized to one of three 30-min exposure conditions: (a) guided threat focus and reappraisal; (b) safety-behavior utilization; or (c) exposure only control. Tripartite outcome assessments during a behavioral approach test, along with measures of suffocation and restriction fears were obtained at pre- and post-treatment, and at a 2-week follow-up. Treatment process measures were collected throughout treatment and consisted of indices of fear activation; within and between-trial fear habituation; and suffocation and entrapment expectancies. Measures of safety behavior utilization and attentional focus were also collected to assess the integrity of the experimental manipulations. Consistent with prediction, those encouraged to utilize safety-behaviors during exposure showed significantly more fear at post-treatment and follow-up relative to those encouraged to focus and reevaluate their core threat(s) during exposure. Moreover, growth curve analyses of treatment process data analyses revealed that safety-behavior utilization exerted a detrimental effect on between-trial habituation; whereas guided threat reappraisal enhanced between-trial habituation.     

On beyond urine: clinically useful assessment instruments in the treatment of drug dependence

Although there are a wealth of clinically useful, brief, and low-cost assessment instruments available for use with drug-dependent populations, relatively few are broadly used in clinical practice. With an emphasis on: (1). the multidimensional nature of drug users' problems; and (2). assessments that can be integrated into empirically validated treatments, clinically useful assessments in four general categories (evaluation and diagnosis of drug dependence, identifying concurrent disorders and problems, treatment planning, and evaluation of treatment outcome) are briefly summarized. Progress in the field of drug abuse treatment has been significantly hampered by the failure to adopt, across research and clinical settings, a common set of assessments.     

Psychological and existential vulnerability among clinical young women: a quantitative comparison of depression-related subgroups

The objective was to explore psychological and existential vulnerability among clinical young women in Sweden. Females (n?=?53) with depression as the most common preliminary diagnosis were investigated through an online questionnaire. Included measures were Karolinska Scales of Personality, Self-concept, Strategies to Handle Negative Emotions, Sense of Coherence, and questions pertaining to existential meaning-making, including religious/spiritual belief. The sample was divided into High (n?=?35) and Low/Inter (n?=?18) groups according to scores on the anxiety- and depression-related personality scale Inhibition of aggression. Using independent samples t-test, the High group showed signs of significantly higher psychological and existential vulnerability than the Low/Inter group. Salutogenic factors being (1) coming from socially and societally engaged families and (2) being in a functional existential meaning-making process. The conclusion is that vulnerabilities in the psychological and existential domains are linked, especially in individuals high on depression-like aspects of personality. However, no significant differences for religion/spirituality were found. Treatment implications were addressed.     

The effect of message framing and the nature of the targeted illness on individuals’ intention to participate in clinical trials

IntroductionClinical trials are considered as the most useful methods to evaluate the efficacy of new medical treatments, but the participation of healthy individuals is often too small, which limits the statistical power of the trial and hence its effectiveness.ObjectiveThe goal of the present research is to assess, for the first time, the effects of message framing (gain versus loss) and of the nature of the illness targeted by a clinical trial (highly- versus mildly-contagious) on individuals’ intention to enter it.MethodsThe experimental manipulation is carried out within a scenario promoting a clinical trial, in a 2 (framing: gain vs loss) × 2 (nature of the illness: highly- vs mildly-contagious) between-participants design. After reading the scenario, participants were asked to rate their intention to enter the trial and their perception of its utility.ResultsStatistical analyses validated a causal model explaining that a gain-framed message describing a highly-contagious illness increases the perception of the utility of the clinical trial, which in turn enhances the intention to participate.ConclusionThe discussion mainly focuses on the contributions of these findings at a theoretical level, considering the limits and potential of their possible application.