Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views

ABSTRACT

Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used “frequently” or “very frequently” by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.     

Knowledge does not necessarily make the heart grow fonder: The moderating role of knowledge on accessibility experiences

Accessibility experiences have been a subject of interest since Tversky and Kahneman (1973) published their account of the availability heuristic—specifically, individuals often utilize the phenomenological experience of ease or difficulty of recall in constructing a judgment (Schwarz, 1998). The reported studies contribute further to work in this area by examining the moderating role of knowledge on accessibility experiences and their use in evaluative judgments. We argue that knowledgeable individuals are more likely to experience interference effects in early stages of recall. This would result in a reversal of the usual phenomenon such that while low knowledge individuals would find recalling larger sets effortful, which would lead them to form more negative evaluations when recalling larger amounts of information, high knowledge individuals would find recalling smaller sets effortful and would form more negative evaluations when recalling smaller amounts of information. We discuss potential explanations and draw attention to the distinction between generating a response and the appropriateness of the response in accessibility experiences.     

Vicarious Trauma in Social Workers: The Role of Trauma History,Social Support,and Years of Experience

Vicarious trauma, a disruption in schemas and worldview often accompanied by symptoms similar to those of posttraumatic stress disorder, occurs as a result of chronic secondary exposure to traumatic material. The aim of this study was to examine the role of personal trauma history, social support, and experience level in the development of vicarious trauma among licensed social workers in Maryland (N = 160). Results indicated an increase in social support and in experience level of social workers predicted less severe vicarious trauma. In addition, an interaction effect between trauma history and social support trending on significance indicated higher levels of social support might help protect those without a trauma history but not those with a trauma history against vicarious trauma. Research and clinical implications are discussed.     

Health Outcomes by Closeness of Sexual Abuse Perpetrator: A Test of Betrayal Trauma Theory

Summary

In this chapter, practicing attorney Brooks Cooper illuminates how the legal tradition of applying different standards to the ad-missibility of expert and lay opinions as evidence in litigation complicates delayed-discovery sexual abuse cases. Admissibility standards have long been a source of controversy, and recent developments in law, such as the pre-trial evidentiary hearings that invoke the “gatekeeper” function of the judge under the standard enunciated in Daubert v. Mer-rell-Dow Pharmaceuticals, have become a favored strategy by the defense in an effort to bar delayed memory testimony by characterizing it as the product of unreliable science. To overcome this litigation hurdle, Mr. Cooper contextualizes the present controversy in the history of scientific evidence admissibility, tracing emerging trends in judicial opinion on scientific evidence from expert witnesses from the 1923 case Frye v. United States through the present, and offers strategies and techniques to maintain admissibility of the evidence before and during all phases of the trial.     

Coping with Intimate Partner Violence: Battered Women's Use and Perceived Helpfulness of Emotion-Focused Coping Strategies

This study investigated intimate partner violence (IPV) victims' emotion-focused coping efforts, as well as their retrospective ratings of the perceived helpfulness of these efforts, in the context of a longitudinal study of battered women's experiences over time. Four hundred and six primarily African American, low-income battered women who had experienced IPV within the previous 12 months were interviewed. Patterns of coping use and perceived helpfulness were explored. The correlation between prevalence of use of emotion-focused coping strategies and perceived helpfulness of these strategies was examined, and results showed that the strategies used by more battered women were less helpful in dealing with feelings about abuse. Implications for clinical interventions with battered women are discussed.     

Deliberate Self-Harm and State Dissociation: An Experimental Investigation

The purpose of this study was to test the relation between deliberate self-harm (DSH) and state dissociation. Participants (N = 85) were randomly assigned to self-administer either a very mild electric shock below their pain threshold (a no-self-harm control condition) or an electric shock they were told could “cause minor tissue damage that would heal quickly,” but which was in fact equal to a predetermined pain threshold (a DSH condition). After task completion, 42 participants rated the extent of their dissociation before the shock and 43 rated the extent of their dissociation after the shock. Results indicated that women in the DSH group experienced more dissociation compared to men, but only after the shock. Potential reasons for this gender effect are discussed.     

Images of God and the imaginary in the face of loss: a quantitative research on Vietnamese immigrants living in Canada

ABSTRACT

This study examines the relationships between images of God, the imaginary and experiences of loss among Vietnamese immigrants living in Canada. One hundred twenty-nine participants completed four sets of questionnaires: a demographic questionnaire, a Questionnaire on God Image, the Brief Symptom Inventory, the Davidson Trauma Scale. In the second phase, 32 participants were administered the AT.9 test (an archetypal test with nine elements). In this test, participants are asked to draw, using nine symbolic elements, and then write a story based on their drawing. Results showed that a positive perception of God negatively correlated with somatisation, anxiety and hostility, whereas negative God image was significantly related to high levels of emotional distress. Results also showed that the synthetic categories of the imaginary were associated with a positive perception of God; and were negatively associated with somatisation, intrusion and hyper-vigilance. Further discussions on the main findings will address cultural implications in the fields of Mental Health, Religion and Culture.     

Activity experiences shape perceived fitness trajectories: Results from a 6-month randomized controlled trial in older women

ABSTRACT

In this study we addressed the subjective benefits of activity interventions that were designed to improve cognitive fitness in old age. Two hundred and fifty-nine women (aged 70–93 years) were randomized to participate in an exercise or a computer course or a control condition for 6 months. Subjective ratings of the perceived change of cognitive and physical fitness components were captured before, during, after the intervention interval, and at a 10-month follow-up. Positive and negative affect levels and objective cognitive fitness parameters served as possible covariates. Multilevel modeling revealed that the computer group rated memory and concentration as having improved at 4 months and again at 6 months. The exercise group, in contrast, perceived physical capacities as maintained or improved. The characteristics of the activity experience seem to determine the perceived fitness changes. We conclude that actual learning experiences improve one's self-concept of abilities.     

The trajectory of psychoanalysis: A prognosticationy3

I present an overview of the development to this point of psychoanalysis as a discipline'both as a theory of the mind and a treatment of the disorders of the mind' and offer a prediction concerning evolving development over its (near) future. My focus is on the coherence of psychoanalysis as a theoretical structure, starting with Freud's strenuous endeavours to maintain the psychoanalysis that he had single‐handedly created as a unitary and unified theory, tracing then the breakdown of this effort, even in Freud's lifetime, into the burgeoning theoretical diversity or pluralism that characterises worldwide psychoanalysis today, and then going on to the beginning appearance of evidences' not yet widely remarked' of growing convergences from within very disparate and even seemingly very opposed theoretical perspectives, at least at the level of technical interventions and experience‐near clinical theory, with implications, however, even for the level of experience‐distant general (metapsychological) theory. Such a development, if sustained, as I anticipate, would strengthen the credibility of psychoanalysis as a science of the mind, amenable to growth through empirical research in accord with the canons of scientific method.     

临床思维学的教学实践与理论探索

思维是人类理性活动的基本方式,思维能力是最具人类特色的能力,临床思维能力的培养是一个非常重要、然而又常为人们所忽视的问题,主要介绍临床思维学的课程设置、主要内容、教学目的和教学效果,通过对教学实践的阶段性总结,对理论体系进行初步的探索,以推动临床思维学的普及和发展,提高临床诊断治疗水平。