Verbal Memory Deficits in Children with Less than 750 g Birth Weight

Numerous studies have documented memory deficits in very low birthweight (VLBW, < 1500 g) children, yet we know little about the nature of these memory problems. To clarify memory sequelae and examine memory deficits in relation to the degree of low birth weight, we administered the California Verbal Learning Test–Children’s Version (CVLT-C) to a regional sample of 57 < 750 g birthweight children and to groups of 53 750–1499 g birthweight children and 49 term-born controls. Group comparisons revealed significant differences between the < 750 g birthweight group and term-born children on measures of list learning, delayed recall, and inaccurate recall. In addition, the percentage improvement in correct recognitions relative to long-term delayed recall was greater in the < 750 g group than in the term-born controls. Similar differences were observed between VLBW children with and without abnormal neonatal cerebral ultrasounds (high- and low-risk groups). Differences in learning rate between the VLBW and term-born groups, and between high- and low-risk VLBW children, were evident even when vocabulary skill was covaried or when children with neurosensory deficits or IQ < 80 were excluded from analysis. The findings document deficits in verbal memory in the subset of VLBW children at greatest biological risk, and suggest that acquisition processes are selectively impaired.     

Issues in training clinical health psychologists

The author describes general issues in the training of clinical health psychologists and provides an overview of specific content needed in core health psychology and clinical health psychology assessment and intervention. Special attention is given to training in professional, personal, ethical and legal issues of practice.     

Risk and Trust in Public Health: A Cautionary Tale

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm.     

Body checking and avoidance in ethnically diverse female college students

Although body checking and avoidance behaviors are common in women with eating disorders, minimal research has examined the nature or correlates of these behaviors in ethnically diverse female college students without eating disorders. Self-identified European American (n = 268), Asian American (n = 163), Latina (n = 146), and African American (n = 73) women completed self-report measures of body checking and avoidance, thin-ideal internalization, eating pathology, and clinical impairment. Results indicated that European and Asian American women reported significantly more body checking and avoidance than African American and Latina women. Generally, correlates of body checking and avoidance were consistent across ethnic groups: Regression analyses indicated that type of ethnicity predicted body checking and avoidance; and ethnicity, body checking, and body avoidance predicted eating pathology and clinical impairment. These associations suggest that body checking and avoidance are not benign behaviors in diverse nonclinical women.     

Personality Disorder Attributes as Supplemental Goals for Change in Interpersonal Psychotherapy

Interpersonal Psychotherapy (IPT) is a manualized, short-term (usually 12–16 sessions) based on the assumption that psychological disorders often emerge secondary to social and interpersonal problems that require active intervention to achieve symptom remission. The time-limited nature of IPT compels therapists to establish the goal of diminishing, on a weekly basis, a small number of focused interpersonal problems with a decided emphasis on proximal rather than historic conflicts and associated patterns of behavior. This strategy discourages the adoption of diffuse therapy goals and directions that have more opportunity to emerge in long-term, unstructured treatment modalities. The role of traditional personality testing in short-term therapy, when it occurs, is to identify and quantify symptom clusters that warrant attention as dependent measures in the treatment process. The role of personality factors in the genesis or maintenance of psychological disturbance is rarely addressed. The present article explores theoretical and pragmatic objections to the use of personality testing in IPT. A method is proposed for the limited but systematic incorporation of personality testing in the IPT treatment process using the Millon Clinical Multiaxial Inventory (MCMI-III). While unreasonable to expect personality transformation through short-term therapy, the partial attenuation of maladaptive behavioral, attitudinal, and emotional reactions to stressors could prove exceedingly helpful to short-term treatments such as IPT.     

University psychology clinics in Australia: Their place in professional training

Abstract: There is universal recognition of the need for developmentally appropriate supervised clinical experience in professional psychology training. University clinics were established to provide a bridging function for postgraduate clinical psychology students, assisting the integration of psychological theory and research into real‐world clinical applications and professional identity development. The aim of training in university clinics is to provide opportunities for clinical practice and high‐quality supervision to monitor and shape clinical skills. The experiences gained in external practicum settings complement this initial training but cannot replace it. The recent introduction of Medicare rebates for psychology services has threatened the survival of university clinics because low‐cost psychological treatment is now available from experienced practitioners. This paper provides data on Australian university clinics collected before the introduction of Medicare. Concerted efforts are needed to protect university clinics in order to maintain standards required for accreditation of clinical psychology training programs. The potential impact of the loss of university training clinics is discussed and strategies to ensure their survival are suggested.     

The multi-level approach: a road map for couples therapy

This paper presents a multi-level framework and road map to guide the therapeutic process. Starting with the couple's reactive pattern, the multi-level approach first orients the therapist on how to create a "holding environment." It then suggests how the therapist, in collaboration with the couple, can proceed to explore interactional, sociocultural/ organizational, intrapsychic, and intergenerational processes that might be fueling the couple's dynamics. Central to this approach is the construct of the vulnerability cycle, a nexus of integration that helps the therapist stay anchored while moving through the many layers of therapeutic work. The overall goal is to help the partners move from reactivity to responsibility for their own feelings and behavior; from impasse to a greater ability to reflect, express feelings, listen, negotiate, and make choices about how to be in the relationship. This paper describes a range of concepts and interventions from basic to complex; it is intended as an organizational tool for practice and clinical training.     

Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial

Outcomes for cognitive-behaviour therapy (CBT) in randomised controlled trials (RCTs) have rarely been compared to those in routine clinical practice. Taking the case of CBT for chronic fatigue syndrome (CFS), we evaluated the results of a successful RCT against those of the same treatment given in the same setting as part of routine practice. Fatigue and social adjustment scores were compared for patients who received CBT for CFS as part of a RCT (N=30) and patients who received CBT as part of everyday clinical practice (N=384). The results in the RCT were superior to those in routine clinical practice. Between pre-treatment and 6-month follow-up, the RCT showed a larger reduction in fatigue and greater improvement in social adjustment than those in routine treatment. The changes in fatigue scores were similar for both groups during treatment but were greater in the RCT between post-treatment and follow-up. Potential reasons for the superior results of the RCT include patient selection, therapist factors and the use of a manualised treatment protocol. Practitioners need to pay particular attention to relapse prevention and ensuring adequate follow-up in addition to encouraging patients to continue with cognitive-behavioural strategies once treatment has ended.     

培养科学的临床思维——由一例延误诊治病例引发的哲学反思

临床工作中,误诊误治在所难免,重要的是我们能否对其进行反思,从中积累经验教训提高诊疗水平。本文首先从哲学的角度分析了造成误诊的原因,然后指出防止或减少误诊的途径是培养科学的临床思维,并提出了在临床过程中培养科学临床思维应注意的8个方面。