公共政策制定程序对政策可接受性的影响

根据程序公正理论提出公共政策制定程序与公众对政策的可接受性的关系问题。研究一通过访谈不同领域的学者,初步揭示了公共政策及其制定程序存在的问题——对公共问题不敏感,解决问题的措施成效低。研究二用问卷调查公众对一个制定中的公共政策的态度,恰与政策制定者的愿望相反,公众并不认可政府解决问题的设想,也不认同政府举行的听证会的结果。研究三设计了一个非等组前后测准实验,在两个互联网站的电子公告板上比较根据不同的公共政策制定程序的政策的可接受性。结果证明,制定政策时了解公众态度可增强政策的针对性,提高解决问题措施的成效和可接受性     

Cognitive testing of an instrument to evaluate acceptability and use of pre-exposure prophylaxis products among women

Given the range of pre-exposure prophylaxis (PrEP) products currently being tested to prevent HIV in women, a standardized Acceptability and Use of PrEP Products Among Women Tool may facilitate comparisons of product acceptability and use across different geographies, trials, and users. We conducted three rounds of cognitive interviewing over 2 months in 2016, with 28 South African women who had experience participating in a range of PrEP product trials. The final instrument contained 41 items, including five new items that improved construct validity and 22 items modified for clarity. Changes were made due to unclear wording, difficulty answering, participant embarrassment, low response variability, and administrative formatting. Cognitive interviewing provided a means to address issues that would have inhibited this tool's ability to accurately collect data otherwise. This rapid, low-cost study provided valuable insight into participants' understanding of questions and demonstrated the utility of cognitive interviewing in international clinical trials.     

Defensive high-anxious individuals with chronic back pain demonstrate different treatment choices and patient persistence

The aim of this study is to determine whether the experience of, and response to chronic back pain was different for defensive high-anxious individuals than other personality types (defensive high-anxious, high-anxious, repressor and low-anxious). Participants (n = 111) were recruited from a heterogeneous sample of individuals who had reported back pain within the last 6 months. Self-report measures of trait anxiety and defensiveness were used to determine personality type. In addition, pain, treatment history, disability, depression and satisfaction with treatment were recorded. Despite reporting similar levels of pain to other personality groups, defensive high-anxious individuals reported significantly greater disability and depression (p < 0.01). Of the defensive high-anxious individuals, 92% sought more than one intervention. In comparison, repressors predominantly self-managed their pain with only 10% utilising more than one intervention. Surprisingly, there were no differences in treatment satisfaction between the four groups. The present study suggests that personality type is an important factor influencing patients’ treatment options, with defensive high anxious individuals substantially more likely to seek multiple interventions and remain within the care system. The present study provides a basis for future research into the role of personality type in the management of chronic pain.     

Treatment-resistant depression: A systematic review of systematic reviews

The objective of this research study was to assess pharmacological, somatic and/or psychological treatments in adults with a diagnosis of major depressive disorder who have not responded to at least one course of antidepressant medication. We conducted a systematic review to identify systematic scientific reviews and meta-analyses on treatment-resistant depression (TRD) published until February 2012. Of the sixty studies selected, sixteen met the inclusion criteria and were therefore included in the review. We considered eight main themes, including the definition of TRD, long-term results, and different treatment strategies, including so-called somatic therapies. Based on the review, the definition of TRD should be standardized in order to achieve a shared conceptualization of this disorder. This would allow a better understanding among clinicians and researchers in the field, promoting a homogeneous research methodology and thus leading to more reliable and comparable results. This essential conceptual clarification would also have a positive impact on patients with TRD, their families, and social and health systems.     

L’évaluation du risque de récidive et l’intervention basée sur les données probantes : les conditions nécessaires à l’implantation de méthodes structurées d’évaluation et d’intervention efficaces

The results of different studies on the best practices of the prevention of recidivism are clear: it is possible to reduce the risk of recidivism of offenders through efficient intervention. Structured risk assessment combined with practices based on risk, need and responsivity principals may reduce the risk of recidivism by up to 30%. These programs, developed primarily in Canada, require adaptations to better suit a French context. The present article proposes to revise the main stages essential to the introduction of a new evaluation and intervention strategy based on evidence, namely, the exploration, the preparation of the establishment, the creation and implementation themselves, the sustainability approach and the introduction of evaluative research studies. The advantages of considering such an implementation strategy are discussed.     

Couple and Family Treatments: Study Quality and Level of Evidence

This paper examines the application of the guidelines for evidence‐based treatments in family therapy developed by Sexton and collaborators to a set of treatment models. These guidelines classify the models using criteria that take into account the distinctive features of couple and family treatments. A two‐step approach was taken: (1) The quality of each of the studies supporting the treatment models was assessed according to a list of ad hoc core criteria; (2) the level of evidence of each treatment model was determined using the guidelines. To reflect the stages of empirical validation present in the literature, nine models were selected: three models each with high, moderate, and low levels of empirical validation, determined by the number of randomized clinical trials (RCTs). The quality ratings highlighted the strengths and limitations of each of the studies that provided evidence backing the treatment models. The classification by level of evidence indicated that four of the models were level III, “evidence‐based” treatments; one was a level II, “evidence‐informed treatment with promising preliminary evidence‐based results”; and four were level I, “evidence‐informed” treatments. Using the guidelines helped identify treatments that are solid in terms of not only the number of RCTs but also the quality of the evidence supporting the efficacy of a given treatment. From a research perspective, this analysis highlighted areas to be addressed before some models can move up to a higher level of evidence. From a clinical perspective, the guidelines can help identify the models whose studies have produced clinically relevant results.     

Coping orientation and psychological distress in healthcare professionals: The utility of appraising coping acceptability

The purpose of this study was to examine interaction effects of healthcare professionals' coping orientation (i.e., engagement versus disengagement) and appraisal of coping acceptability (ACA) on psychological distress, taking into account the individuals' job specificity and the psychological climate in their work environment. A cross‐sectional survey was conducted, and Japanese healthcare professionals (N = 189; 117 female; mean age: 40.1 ± 11.2 years) reported the coping strategies that they employed for task‐related or interpersonal stressors, their cognitive appraisal of the stressors, their ACA, and the psychological distress evoked by the stressors. The results showed that adding consideration of the ACA to the variable of coping orientation significantly improved predictions of psychological distress for both task and interpersonal stressors. There was no significant interaction between the coping orientation and the use of coping strategies that incorporated the ACA. These results suggest that considering the ACA, in addition to the coping orientation, would be useful for understanding individual differences in the mediators of healthcare professionals' coping in stressful situations.     

Are all safety behaviours created equal? A comparison of novel and routinely used safety behaviours in obsessive-compulsive disorder

Contamination fear is one of the most common symptoms of obsessive-compulsive disorder (OCD). Exposure and response prevention (ERP) is effective for OCD, but a significant minority of treatment-seeking individuals refuse ERP entirely or drop out prematurely. Research suggests that safety behaviour (SB) may enhance the acceptability of ERP; however, questions remain about how to incorporate SB into existing treatments. Clinical participants with OCD and contamination fear (N = 57) were randomized to receive an exposure session with no SB (ERP), a routinely used SB (RU), or a never-used SB (NU). Significant reductions in contamination fear severity were observed in all conditions. Although omnibus comparisons were only marginally significant, pairwise comparisons revealed some condition differences. NU demonstrated significantly lower self-reported contamination fear severity at post-exposure, as well as marginally higher treatment acceptability ratings. Findings suggest that exposure with SB may be effective and acceptable, and are discussed in terms of cognitive-behavioural theory and treatment of anxiety and related disorders.     

Perceptions of self-efficacy in providing multidimensional school-age stuttering therapy among board certified fluency specialists in the United States

PurposeThe purpose of this study was to document fluency specialists’ self-efficacy beliefs for providing multidimensional treatment to children who stutter and to identify cognitive, affective, and behavioral correlates of self-efficacy.MethodSixty-six Board Certified Specialists in Fluency in the United States completed an online survey measuring self-efficacy in providing multidimensional stuttering therapy, perceived importance of multidimensional aspects of therapy, feelings of comfort in providing therapy, perceived treatment success, and employment and demographic questions. Open-ended questions were also asked for participants to describe why they chose to specialize and what benefits they received from it.ResultsParticipants reported high levels of self-efficacy (averages above 9 on a scale from 0 to 10) in speech-related, cognitive, emotional, and social domains of stuttering therapy, as well as high levels of comfort and clinical success. Higher ratings of overall self-efficacy were significantly correlated with beliefs about the importance of multidimensional treatment, τ = 0.27, treatment comfort, τ = 0.25, and self-reported treatment success, τ = .49. Responses indicated that many participants believed that their self-efficacy grew because of specialty certification.ConclusionAlthough not the same as treatment outcome data, self-efficacy among clinical service providers is an important variable to consider. Board Certified Specialists in Fluency in the United States report very high levels of self-efficacy for school-age stuttering treatment. The process of certification helps to increase self-efficacy and provides a means for advertising competence in stuttering treatment. This information could help in recruiting the next generation of fluency specialists.     

Tobacco Use Predicts Treatment Dropout and Outcome in an Acute,Transdiagnostic Psychiatric Treatment Setting

Tobacco use is consistently associated with greater levels of depression and anxiety, broadly, and preliminary evidence suggests that current tobacco use is a significant predictor of dropout from psychiatric treatment. The current study extends past work to examine the impact of tobacco use on treatment dropout and outcomes in an acute psychiatric treatment setting. Upon intake to a partial hospitalization program (PHP), patients completed a battery of measures assessing sociodemographic characteristics, current tobacco use, depression and generalized anxiety, and substance use. Patients at the PHP also completed measures assessing levels of depression and generalized anxiety again upon discharge from the program. In line with hypotheses, current tobacco use was a significant predictor of dropout from treatment at the PHP. Importantly, this relationship remained significant when statistically controlling for demographic variables and psychiatric and substance use severity (such as number of previous inpatient psychiatric hospitalizations and degree of alcohol or drug problems). Results from the current study indicate that tobacco use is a significant risk factor for treatment dropout. Further research is needed to replicate these findings and to determine the mechanism underlying this link between tobacco use and treatment dropout for people receiving intensive psychiatric care.