Developing coherence in community and clinical psychology: the integration of idealism and pragmatism

Illustrations of how ideas from community psychology may be integrated with clinical psychological thinking and practice are described from the perspective of a clinical psychologist working in the NHS. The intentions are to consider socially relevant conceptualizations of the causes of people's well-being and distress, and to develop ways of helping individuals and communities to clarify and address these causes. Incorporating an analysis of social power also necessitates a critical awareness of the limited potency of psychological interventions. © 1998 John Wiley & Sons, Ltd.     

No Easy Answers: Avoiding Potential Pitfalls of De‐implementation

In 2012, the Centers for Disease Control and Prevention (CDC) began to de‐emphasize and de‐implement multiple evidence‐based HIV prevention practices that had been around for 20 years, thus changing the scope of implementation across the globe. The authors provide evidence how existing interventions (e.g., CDC HIV interventions) may influence implementation of interventions that came after the program was discontinued. De‐implementation is an ecological event that influences, and is influenced by, many parts of a system, for instance, implementation of one type of intervention may influence the implementation of other interventions (biomedical and/or behavioral) after a long‐running program is discontinued. Researchers and policy makers ought to consider how de‐implementation of behavioral interventions is influenced by biomedical interventions mass‐produced by companies with lobbying power. The scientific study of de‐implementation will be inadequate without consideration of the political climate that surrounds de‐implementation of certain types of interventions and the promotion of more‐profitable ones.     

Similarity to prototypical heavy drinkers and non-drinkers predicts AUDIT-C and risky drinking in young adults: prospective study

Objective: The aim of the present study was to explore whether constructs within the Prototype Willingness Model (PWM) predicted risky drinking as measured by AUDIT-C, drinking harms and unplanned drunkenness in a sample of UK young adults. Previous studies exploring the PWM often do not use validated measures of alcohol consumption, and the outcomes of risky drinking are underexplored. Design: An online prospective study design with 4 week follow-up was employed and 385 young adults completed the study (M age?=?21.76, SD?=?3.39, 69.6% female; 85.2% students). Main outcome measures: Intentions to get drunk, AUDIT-C, drinking harms experienced in the last 4 weeks, and unplanned drunkenness in the last 4 weeks. Results: Heavy and non-drinker prototype similarity predicted AUDIT-C, drinking harms and unplanned drunkenness when controlling for past behaviour and reasoned action pathway constructs. Intentions and willingness both mediated the relationship between prototype perceptions and AUDIT-C. Conclusion: This study supports the use of the PWM in the prediction of AUDIT-C, drinking harms and unplanned drinking in a UK sample. Prototype perceptions influenced behaviour via both reasoned and reactive cognitions. Targeting similarity to heavy and non-drinker prototypes should be the focus of future interventions in this population.     

The relationship between self-efficacy,readiness to change,and AUDIT risk levels in a sample of active duty emergency department patients

The purpose of this study was to test the relationship between self-efficacy, readiness to change, and Alcohol Use Disorders Identification Test (AUDIT) risk levels in a sample of active duty drinkers who were seeking care in a military emergency department. Civilian health educators screened participants for alcohol use with the AUDIT and collected sociodemographic, service, and drinking-related cognitions data from active duty patients admitted to an emergency department. A total of 787 active duty military personnel participated in the study. Almost half (48%) drank at least once a week and 32% reported consuming five or more alcoholic drinks during a typical drinking episode. One in five participants reported heavy episodic drinking weekly to almost daily. Results of a multinomial logistic regression model showed that active duty service members with a self-reported diagnosis of posttraumatic stress disorder since joining the military were more likely to be an at-risk or high/severe risk drinker relative to a low risk drinker. Higher controlled drinking self-efficacy was associated with a decrease in the odds of being either an at-risk or high/severe risk drinker. Increased readiness to reduce drinking was associated with an increase in the odds of being either an at risk or high/severe risk drinker. The results of this research suggest self-efficacy to control one’s heavy drinking as well as readiness to change may be important factors to consider when designing alcohol education programs within the military.     

No evidence that alcohol intoxication impairs judgments of learning in face recognition

Alcohol use is frequently involved in crime, making it crucial to understand the role of alcohol in facial recognition to maximize correct perpetrator identifications. Although the majority of the alcohol and face recognition research has investigated recognition with retrospective confidence judgments, we examined the effects of alcohol intoxication on face recognition with prospective metacognitive judgments. Participants (N = 54 university students without a history of hazardous alcohol/substance use) consumed either alcohol (mean breath alcohol concentration of 0.06 at pretest and 0.07 at post‐test) or a non‐alcoholic placebo drink. Participants then studied unfamiliar male and female faces and made judgments of learning (JOLs) for each face (i.e., predicted the likelihood of recognizing that face on a future memory test). After a brief distractor task, participants completed an old–new recognition test on which they attempted to distinguish the studied faces from new faces. It was found that the alcohol manipulation had minimal effect on face recognition performance or judgments of learning. Our results suggest that theory‐based cues about the effects of alcohol might play a greater role in retrospective judgments than prospective judgments. Although not a primary focus of the study, face recognition was better for male faces than female faces, and this occurred for both female and male participants. Limitations and implications of the research are discussed.     

And one more for the road: Commentary on the Special Issue on alcohol and eyewitness memory

Studies examining the influence of alcohol intoxication have reported mixed findings on whether it impairs eyewitness memory. Although the studies in this Special Issue investigated different questions and tested different variables, the findings of these studies collectively provide insight into mechanisms and methodological issues that may explain the ambiguous findings of alcohol intoxication and eyewitness memory. In this commentary, we first describe the experimental studies of this Special Issue. We then discuss four mechanisms that could underlie those mixed findings (alcohol myopia, disinhibition, hypervigilance, and metacognitive processes at retrieval). Last, we address methodological issues that may have contributed to those ambiguous findings (i.e., alcohol intoxication levels, automatic processing of stimuli, sensitivity of dependent variables, and possible interactions with arousal) and provide suggestions for future research to address these issues.     

Efficacy of a Brief,School‐Based Bystander Bullying Intervention on High School Students' Alcohol Use

The authors examined the efficacy of a brief bystander bullying intervention on reducing alcohol use among high school students (N = 61). As hypothesized, high‐risk drinkers in the intervention group reported reduced drinking compared with control students at a 30‐day follow‐up.     

Using Multiple Contexts and Retrieval Cues in Exposure-Based Therapy to Prevent Relapse in Anxiety Disorders

The benefits of exposure-based interventions for anxiety disorders are substantial but not stable for everyone, given that these interventions are often followed by relapse of symptoms. A body of research provides a background on how to add certain strategies in exposure-based therapy to prevent relapse in anxiety disorders. This review summarizes some of these strategies and provides clear-cut clinical implications. Studies that provide support for two types of strategies to prevent relapse have been reviewed—the use of multiple contexts and the use of retrieval cues. The use of multiple contexts reduces context and stimulus specificity of extinction learning during exposure, while the use of retrieval cues enhances memory (re)consolidation and retrieval after exposure. The described strategies to enhance the accessibility and therefore the retrievability of exposure-based learning to prevent relapse in anxiety disorders can be summarized as advice to conduct exposure under variable conditions. This way, the generalizability of what is learned during exposure to the patients’ daily life after treatment improves. Therefore, adding these strategies in the course of exposure-based treatment of anxiety disorders seems beneficial. However, future replications and translational studies are needed to verify ecological validity.     

The relationship between religion and health-related behaviours in patients with borderline personality disorder

With addictive disorders frequently co-occurring among patients with borderline personality disorder (BPD), exploring factors that may influence health-related behaviours, like religious involvement, is important. This study assesses whether religious involvement is associated with smoking and alcohol use disorders (AUDs) in BPD subjects. This study used data from Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), which used the Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV (AUDADIS-IV) as its assessment instrument. The AUDADIS-IV assessed personality disorders, tobacco usage, the presence of AUDs, and religious involvement. Attending a place of worship and weekly or more frequent worship attendance were significantly associated with reduced likelihood of current smoking and AUDs among BPD subjects. AUDs were also significantly less common in those reporting higher subjective religiousness. In conclusion, people with BPD who are religiously inclined are less likely to engage in addictive behaviours, specifically smoking and AUDs.