循证医学的辩证思维

随着临床医学的发展,临床医生面临着从理论知识加个人经验的医学模式向以科学证据为基础的医学模式转变。越来越多的卫生政策和诊疗指南的制定需要以高质量的研究结果为依据,如随机对照研究的结果,特别是随机对照研究的系统综述结论。循证医学模式要求医生在临床工作中不断提出问题并通过严格的科研设计来回答这些问题,同时强调不断进行知识更新,掌握最新研究证据以指导其临床工作。同时政府部门也鼓励发展循证医疗,因为它可通过研究有效的诊疗手段来提高卫生保健的效率。此外还有迹象表明法律决策过程中要参考是否遵循了研究证据和临床指南。知情的服务对象也促使临床工作者寻求研究证据作为依据,为了提高服务质量并且充分把握特殊专业领域的现状,临床工作者也需要不断了解新的依据信息。在众多的研究信息中,我们应对每项证据的研究方法、研究对象及观察的终点进行认真分析,确定该结论是否真实并适合我们的实际,从而制定有据可查的诊疗方案。     

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

A Systematic Review: Non‐Suicidal Self‐injury in Australia and New Zealand's Indigenous Populations

Objective

To undertake a systematic review of non‐suicidal self‐injury (NSSI) prevalence, patterns, functions, and behavioural correlates for the Indigenous populations of Australia (Aboriginal and Torres Strait Islanders) and New Zealand (NZ; Maori).

Method

We searched the following electronic databases: PubMed, MedLine, Scopus, Web of Science, ScienceDirect, PsycInfo, and PsycArticles, CINAHL, and the Informit Health and Indigenous Peoples collections. Studies were included for review if they were published within the last 25 years and reported on NSSI in Australia and NZ's Indigenous populations.

Results

Seven studies were included, six of which came from Australia. The prevalence of NSSI in Australia ranged from 0.9% up to 22.50%; statistics varied by the different samples, types of prevalence, and relationship to alcohol. Several studies found that Aboriginal and Torres Strait Islander peoples had higher rates of NSSI than other Australians, but that this was not significantly higher. Two studies indicated that NSSI was linked to alcohol use, incarceration, and a younger age. The one NZ study was of injury and not specifically NSSI.

Conclusions

Findings are limited due to a small pool of literature. Cultural variations in NSSI presentation should be considered when working with Indigenous populations. Further research is required to help determine what cultural variations may exist.     

Reducing reactive aggression in schoolchildren through child,parent, and conjoint parent‐child group interventions: An efficacy study of longitudinal outcomes

This study was the first to evaluate the effectiveness of three different group interventions to reduce children's reactive aggression based on the social information processing (SIP) model. In the first stage of screening, 3,734 children of Grades 4–6 completed the Reactive–Proactive Aggression Questionnaire (RPQ) to assess their reactive and proactive aggression. Respondents with a total score of z ≥ 1 on the RPQ were shortlisted for the second stage of screening by qualitative interview. Interviews with 475 children were conducted to select those who showed reactive aggression featuring a hostile attributional bias. Finally, 126 children (97 males and 29 females) aged 8 to 14 (M = 9.71, SD = 1.23) were selected and randomly assigned to one of the three groups: a child group, a parent group, and a parent–child group. A significant Time × Intervention effect was found for general and reactive aggression. The parent–child group and child group showed a significant drop in general aggression and reactive aggression from posttest to 6‐month follow‐up, after controlling for baseline scores, sex, and age. However, the parent group showed no treatment effect: reactive aggression scores were significantly higher than those in the child group at 6‐month follow‐up. This study has provided strong evidence that children with reactive aggression need direct and specific treatment to reconstruct the steps of the SIP involving the selection and interpretation of cues. The intervention could help to prevent severe violent crimes at the later stage of a reactive aggressor.     

The relation between remembered parental acceptance in childhood and self‐acceptance among young Turkish adults

This study examined the relation between young adults' age and remembrances of parental acceptance in childhood, and their current self‐acceptance. The study was based on a sample of 236 young adults in Turkey (139 women and 97 men). The adult version of the Parental Acceptance‐Rejection/Control Questionnaire for mothers and fathers along with the Self‐Acceptance subscale of the Psychological Well‐Being Scale, and the Personal Information Form were used as measures. Results showed that both men and women tended to remember having been accepted in childhood by both their mothers and fathers. Women, however, reported more maternal and paternal acceptance in childhood than did men. Similarly, the level of self‐acceptance was high among both men and women. However, women's self‐acceptance was higher than men's. Correlational analyses showed that self‐acceptance was positively related to remembrances of maternal and paternal acceptance among both women and men. Results indicated that age and remembered paternal acceptance significantly predicted women's self‐acceptance. Age and remembered maternal acceptance made significant and independent contributions to men's self‐acceptance. Men's remembrances of paternal acceptance in childhood did not make significant contribution to their self‐acceptance. Finally, the relation between women's age and self‐acceptance was significantly moderated by remembrances of paternal acceptance in childhood.     

The Romanian Pentecostal Agency for Foreign Mission (APME): A Case Study in Cross‐Cultural Mission Originating from Eastern Europe

This paper offers a short analysis of the ecclesiological and missiological context that led to the establishment of the Romanian Pentecostal Agency for Foreign Mission (APME). It states the main steps in the process of the development of the organization in its first decade of existence (2006–2016), during which it became one of the youngest and most dynamic missionary structures in Europe. It describes the process of the birth of APME and the important role the founding team played in the existence of the agency and in articulating the mission, vision, values, and work philosophy. The main section will present the components of APME's work strategy which led to implementing the vision and reaching the objectives: mobilizing the churches, recruiting, training, sending, supporting missionaries, and promoting the ministry. A short section will show the crucial importance of internal and foreign partnerships in the activity of APME. In the final part we will list the main lessons learned in the ten years of APME's existence that can be shared with other mission organizations, as well as the challenges that the organization faces over the next few years.