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.     

The place of once-weekly treatment in the work of an analytically trained child psychotherapist

In this paper, I explore how we might link ideas about clinical facts to current issues in child psychotherapy research. I consider what our understanding of clinical facts might contribute to our research methods and how our research methods might better represent the clinical facts. The paper introduces a selection of psychoanalytic writers' formulations of the concept and describes some of the debates about the shortcomings of the traditional style of case reporting. The importance of keeping emotional experience central in our research is discussed. I describe a research method that I believe has the potential to capture and describe some of the complicated processes of change in psychotherapy. This is the concept of the ‘turning point’ session. Introducing the paradigm of complexity theory, I briefly explore how we might think about and understand the relationship between processes revealed through detailed analysis of a single session and change over a longer period of therapy.     

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.     

Stress‐related exhaustion disorder – clinical manifestation of burnout? A review of assessment methods,sleep impairments,cognitive disturbances,and neuro‐biological and physiological changes in clinical burnout

The aim of this paper was to provide an overview of the literature on clinically significant burnout, focusing on its assessment, associations with sleep disturbances, cognitive impairments, as well as neurobiological and physiological correlates. Fifty‐nine English language articles and six book chapters were included. The results indicate that exhaustion disorder (ED), as described in the Swedish version of the International Classification of Diseases, seems to be the most valid clinical equivalent of burnout. The data supports the notion that sleep impairments are causative and maintaining factors for this condition. Patients with clinical burnout/ED suffer from cognitive impairments in the areas of memory and executive functioning. The studies on neuro‐biological mechanisms have reported functional uncoupling of networks relating the limbic system to the pre‐frontal cortex, and decreased volumes of structures within the basal ganglia. Although there is a growing body of literature on the physiological correlates of clinical burnout/ED, there is to date no biomarker for this condition. More studies on the role of sleep disturbances, cognitive impairments, and neurobiological and physiological correlates in clinical burnout/ED are warranted.     

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 Effectiveness of Functional Family Therapy in Reducing Adolescent Mental Health Risk and Family Adjustment Difficulties in an Irish Context

To evaluate the effectiveness of Functional Family Therapy (FFT) 42 cases were randomized to FFT and 55 to a waiting‐list control group. Minimization procedures controlled the effects of potentially confounding baseline variables. Cases were treated by a team of five therapists who implemented FFT with a moderate degree of fidelity. Rates of clinical recovery were significantly higher in the FFT group than in the control group. Compared to the comparison group, parents in the FFT group reported significantly greater improvement in adolescent problems on the Strengths and Difficulties Questionnaire (SDQ) and both parents and adolescents reported improvements in family adjustment on the Systemic Clinical Outcomes and Routine Evaluation (SCORE). In addition, 93% of youth and families in the treatment condition completed FFT. Improvements shown immediately after treatment were sustained at 3‐month follow‐up. Results provide a current demonstration of FFT's effectiveness for youth with behavior problems in community‐based settings, expand our understanding of the range of positive outcomes of FFT to include mental health risk and family‐defined problem severity and impact, and suggests that it is an effective intervention when implemented in an Irish context.     

Technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.     

Object recognition and Random Image Structure Evolution

We present a technique called Random Image Structure Evolution (RISE) for use in experimental investigations of high-level visual perception. Potential applications of RISE include the quantitative measurement of perceptual hysteresis and priming, the study of the neural substrates of object perception, and the assessment and detection of subtle forms of agnosia. In simple terms, RISE involves the measurement of perceptual and/or neural responses as visual stimuli are systematically transformed—in particular, as recognizable objects evolve from, then dissolve into, randomness. Points along the sequences corresponding to the onset and offset of subjects’ percepts serve as markers for quantitatively and objectively characterizing several perceptual phenomena. Notably, these image sequences are created in a manner that strictly controls a number of important low-level image properties, such as luminance and frequency spectra, thus reducing confounds in the analysis of high-level visual processes. Here we describe the RISE paradigm, report the results of a few basic RISE experiments, and discuss a number of experimental and clinical applications of this approach.     

Experimental psychopathology, clinical science, and practice: An irrelevant or indispensable alliance?

Psychopathology research is the scientific foundation for legitimate and credible forms of clinical practice and the ethical delivery of mental health services. Experimental psychopathology is a subfield of psychopathology research; its aims are to elucidate variables and processes that contribute, either in whole or in part, to the etiology, exacerbation, or maintenance of abnormal behavior. To date, experimental psychopathology has been poorly understood with regard to its identity, aims, history, and relevance for clinical practice. In this article, we critically review and address the role of experimental psychopathology in the contemporary field of clinical science and practice. Overall, we suggest that experimental psychopathology can maintain its important contributions to the field, and perhaps more important, adapt to the current health care context to have an even larger impact on directing conceptual and empirical analyses of core psychopathology processes.     

Teaching Clinical Psychology Trainees about Weight Bias

Abstract

As an assistant professor who teaches clinical psychology trainees about social aspects of behavior, I devote one week to the topic of weight bias. In this class, I rely on the research literature to challenge common myths about “obesity,” demonstrate the pervasiveness and harm of weight bias, and offer recommendations to trainees to apply to their own professional and personal lives. I encourage trainees to shift focus from weight and weight loss to health and well-being and to engage in self-reflection on the role of weight bias in their interactions with others. Here, I describe my weight bias seminar and outline common questions and my responses to them (e.g., Do you actually believe that “obese” people can be healthy?). Weight bias is a neglected topic in most clinical psychology training programs. Weight bias must be addressed in clinical psychology programs to produce culturally competent graduates who are aware of diversity issues.