Manualizing psychotherapy: Aaron T. Beck and the origins of Cognitive Therapy of Depression

Abstract

This paper examines the origins of psychiatrist Aaron T. Beck’s 1979 Cognitive Therapy of Depression (CTOD). CTOD was the first psychotherapy manual designed to be used in a randomized controlled trial (RCT). Making psychotherapy amenable to the RCT design had been a ‘holy grail’ for leading American psychotherapy researchers since the late 1960s. Beck’s CTOD – which standardized his treatment so it could be compared with drug treatments in a clinical trial – delivered that holy grail, and ushered in the manualized treatment revolution. Manuals are now a sine qua non in psychotherapy research. In this paper, I explore some of the personal, political, and economic variables that made the idea of a manual irresistible to Beck and to those who first championed him.     

‘You have to treat the person,not the mouth only’: UK dentists’ perceptions of communication in patient consultations

Effective communication between patients and health professionals is a key component of patient-centred care. Although there is a large body of literature focusing on doctor-patient communication, there has been limited research related to dentist-patient communication, especially presented from the dentists’ perspective. The aim of our study was to explore UK dentists’ perceptions of communication in their consultations, and the factors they perceive may influence this. We conducted semi-structured interviews with eight dentists in UK dental NHS practices. Thematic analysis revealed three themes (‘Treating the whole person’, ‘Barriers to patient-centred communication’ and ‘Mutuality of communication’), which reflected the dentists’ perceptions of their own communication during consultations, the patients’ interaction skills, attitudes (and characteristics that may affect them), and external factors, such as time constraints, that can influence dentist-patients’ encounters. These in-depth accounts are valuable, in that we see what dentists perceive is important, obstructive and facilitative. They report using a patient-centred approach in their everyday dental practice; however this is often difficult due to factors such as time constraints. Although they emphasized that the patient has an active role to play in the communication process, it may be the case that they also need to play their part in facilitating this.     

Traduction et adaptation du TEI-SF afin de documenter l’acceptabilité sociale de l’intervention comportementale intensive

Early intensive behavioral intervention is more widely used in large-scale community-based services in Autism Spectrum Disorder. There is an increased need to evaluate the social acceptability of these programs. The present study used a measure of social acceptability as part of a social validation procedure to evaluate a community-based EIBI offered in inclusive childcare, as well as two focused interventions associated with this program. To do so, the Treatment Evaluation Inventory Short-form (TEI-SF) questionnaire was adapted and translated to French. The validation results for the TEI-SF, as well as for the social acceptability of the EIBI programs and procedures, are presented. The results are the first evidence of the validity of the TEI-SF (adapted and translated to French), presenting scores of validity of intervention and a favourable perspective related to the early intensive behavioral intervention and opening the door to further research.     

Crossing road intersections in old age—With or without risks? Perceptions of risk and crossing behaviours among the elderly

Pedestrians aged over 65 are known to be a critical group in terms of road safety because they represent the age group with the highest number of fatalities or injured persons in road accidents. It is widely recognized that the latter is due to the physical vulnerability of this age group in case of injury. However, physical and cognitive decline come into play during the action of crossing a street. Various studies have attempted to connect the crossing behaviours of the elderly with variables such as age, gender, sensory acuity, level of attentiveness, physical decline and the design of intersections. In demonstrating the complexity of the relationship between people and their environments, the literature suggests that age, physical ability, and the spatial configuration of roads are major components of road safety. Moreover, people’s knowledge and mastery of their environments, as well as their ability to adapt to change affects how they move through space. Taking these factors into account, this study examines the perceptions of elderly pedestrians with regards to the quality and risks of road crossings in the context of Montréal, Québec, in Canada. The analyze are based on observations and questionnaires in order to bring to light a better understanding of the relationship between the crossing behaviours, characteristics and perceptions of the elderly. While previous studies have examined perception and observation separately, this study is unique in having looked at both angles simultaneously. Five profiles of elderly people in both urban and suburban environments were established. A sample of 181 elderly pedestrians (65–93 years of age, AVG = 74) were surveyed using a questionnaire. In addition to close-ended questions, respondents were asked to evaluate 17 environmental ambiance and risk behaviours according to various scales. Using principal component analysis (PCA) and hierarchical cluster analysis (HCA), the data was grouped into 6 categories that define and distinguish 7 profiles of elderly people. These profiles were explored according to the socioeconomic status and crossing behaviours of respondents. The probabilities of adopting different crossing behaviours were tested by employing logistic regression models. The results reveal greater variability in the perceptions of the elderly in terms of risk related to crossing behaviours and type of signalisation at intersections. Even among seniors, the perceptions of risk varied greatly, which may have had an impact on their behaviours. While some of the behaviours observed coincided with the perceptions of respondents, the results of this study suggest that they only play a marginal role.     

Professional drivers’ fatigue as a problem of the modern era

ObjectiveAll around the world numerous studies have been carried out and indicated that 20–50% of commercial vehicle accidents occur because of fatigue. Professional drivers represent an important category of drivers who are present in traffic on a daily basis transporting passengers or goods and their responsibility is at a very high level. These drivers are most exposed to the impact of fatigue. The review of the literature has provided three main factors which can influence the onset of fatigue: sleep factors, work factors, health factors. The main aim of this study was to determine the influence of the three main factors of fatigue between bus and truck drivers in the Republic of Serbia.MethodsThe survey has been conducted among bus and truck drivers who are employed in transportation companies across the Republic of Serbia. The research consists of collecting and analyzing bus and truck drivers’ answers according to the above mentioned factors which influence the occurrence of fatigue.ResultsIn this study we have found that circadian rhythm, sleep and work factors have an impact on drivers’ fatigue. On the other side, time of going to sleep has no impact on the quality of sleep and on fatigue. The results show that if the drivers work over the legal limit, they are 3 times more likely to sleep less than 6 h in 24 h and if they sleep less than 6 h, it is likely that the poor quality of their sleep will be 8 times higher. The poor quality of sleep reduces driver performance, and therefore increases the risk of accidents.Conclusions2 of 3 investigated factors have an impact on the occurrence of fatigue. The third factor, health factor, should be examined in more detail, and other elements should be analysed in order to determine their influence on the fatigue.     

Investigating cycling kinematics and braking maneuvers in the real world: e-bikes make cyclists move faster,brake harder,and experience new conflicts

Pedelecs (e-bikes), which facilitate higher speeds with less effort in comparison to traditional bicycles (t-bikes), have grown considerably in popularity in recent years. Despite the large expansion of this new transportation mode, little is known about the behavior of e-cyclists, or whether cycling an e-bike increases crash risk and the likelihood of conflicts with other road users, compared to cycling on t-bikes. In order to support the design of safety measures and to maximize the benefits of e-bike use, it is critical to investigate the real-world behavior of riders as a result of switching from t-bikes to e-bikes.Naturalistic studies provide an unequaled method for investigating rider cycling behavior and bicycle kinematics in the real world in which the cyclist regularly experiences traffic conflicts and may need to perform avoidance maneuvers, such as hard braking, to avoid crashing. In this paper we investigate cycling kinematics and braking events from naturalistic data to determine the extent to which cyclist behavior changes as a result of transferring from t-bikes to e-bikes, and whether such change influences cycling safety.Data from the BikeSAFE and E-bikeSAFE naturalistic studies were used in this investigation to evaluate possible changes in the behavior of six cyclists riding t-bikes in the first study and e-bikes in the second one. Individual cyclists’ kinematics were compared between bicycle types. In addition, a total of 5092 braking events were automatically extracted after identification of dynamic triggers. The 286 harshest braking events (136 cases for t-bike and 150 for e-bike) were then validated and coded via video inspection.Results revealed that each of the cyclists rode faster on the e-bike than on the t-bike, increasing his/her average speed by 2.9–5.0 km/h. Riding an e-bike also increased the probability to unexpectedly have to brake hard (odds ratio = 1.72). In addition, the risk of confronting abrupt braking and sharp deceleration were higher when riding an e-bike than when riding a t-bike.Our findings provide evidence that cyclists’ behavior and the way cyclists interact with other road users change when cyclists switch from t-bikes to e-bikes. Because of the higher velocity, when on e-bikes, cyclists appear to have harder time predicting movements within the traffic environment and, as a result, they need to brake abruptly more often to avoid collisions, compared with cycling on t-bikes. This study provides new insights into the potential impact on safety that a cycling society moving to e-bikes may have, indicating that e-cycling requires more reactive maneuvers than does cycling traditional bicycles and suggesting that any distractive activity may be more critical when riding e-bikes compared to traditional bikes.     

Investigating the effectiveness of perceptual treatments on a crest vertical curve: A driving simulator study

Rural roads are characterized by a high percentage of run-off-the-road accidents and head-on collisions, mainly caused by inappropriate speeds and failure to maintain a proper lateral position along the roadway alignment. Among several road safety treatments, low-cost perceptual measures are considered an effective tool, as they generally increase the risk perceived by drivers, or even alter the drivers’ speed perception, and consequently tempting them to decrease their speeds. Their effectiveness has been widely recognized in a number of studies, especially with respect to road intersections and curves.The overall aim of this study is to investigate the effects of different perceptual treatments on driving speed, along a crest vertical curve of an existing two-lane rural road, in order to identify the most effective measure to reduce speed and define its subsequent implementation in the field. Three perceptual treatments were tested using a driving simulator: white peripheral transverse bars, red peripheral transverse bars and optical speed bars, with each one being painted along the approaching tangent to the crest vertical curve. The effects of these speed-reducing measures were investigated using a sample of forty-four participants, by comparing the driving speeds with those recorded under a baseline condition (without a treatment); these were also used to validate the driving simulator’s speed measurements with those found in the field. Moreover, subjective measures were collected, consisting of the driver’s static evaluation of the desired speed, risk perception and markings comprehension, based on screen shot pictures that represented the simulated configurations of the treatments.The findings demonstrated an overall effectiveness of the perceptual treatments, although only the red peripheral transverse bars were found to significantly reduce the driving speeds (−6 km/h). The analysis of the questionnaire yielded interesting information and demonstrated the importance of performing driving simulation tests for evaluating the effectiveness of perceptual treatments.Finally, the results confirmed the enormous potential of using driving simulators to pinpoint a number of speed-reducing measures, and consequently select the most effective one that reduces cost and promotes safety before its actual implementation in the field.     

Tisha B’Av, “Ghetto Day,” and producing “authentic” Jews at postwar Jewish summer camps

The postwar period brought sweeping changes for American Jews. Communal socioeconomic transitions and the aftermath of the Holocaust triggered intense anxieties among Jewish leaders regarding the preservation of so-called Jewish “authenticity,” and to an increased focus on the moulding of American Jewish youth. This article considers how Jewish summer camps used Tisha B’Av and secular, alternative memorial days, to lead campers toward various, ideologically imbued visions of Jewish authenticity. Through fostering an aura of tragedy in what was otherwise a world of play, songs, and enjoyment, Jewish educators used memorial days as transformative educational tools. Though camps’ ceremonies looked remarkably similar, often including a carefully crafted sombre atmosphere, dirges, and responsive readings, the message of the days proved malleable to different ideological perspectives. This article considers how Zionist, Yiddishist, Reform and Conservative camps came to use memorial days to produce “real,” “ideal,” or “authentic” Jews in accordance with their ideological visions in the decades immediately following the Holocaust.     

IN PRAISE OF A LOGIC OF DEFINITIONS THAT TOLERATES Ω‐INCONSISTENCY

I argue that a general logic of definitions must tolerate ω‐inconsistency. I present a semantical scheme, , under which some definitions imply ω‐inconsistent sets of sentences. I draw attention to attractive features of this scheme, and I argue that yields the minimal general logic of definitions. I conclude that any acceptable general logic should permit definitions that generate ω‐inconsistency. This conclusion gains support from the application of to the theory of truth.     

政策执行偏差严重程度对公众地方政府责任判断的影响机制

为探讨地方政府政策执行偏差严重程度对公众地方政府责任判断的影响机制。采用问卷法对728名社会公众进行调查,结果显示：（1）公众地方政府有意性判断和公众地方政府可控归因中介了政策执行偏差严重程度与公众地方政府责任判断之间的关系。（2）政策执行偏差严重程度还通过公众地方政府有意性判断→公众地方政府可控归因的中介链作用于公众地方政府道德责任判断。并对研究的实践启示进行了讨论。