The Gap Between Science and Practice: How Therapists Make Their Clinical Decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists’ practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists’ choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists’ theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.     

The mark of adaptive memory in healthy and cognitively impaired older adults and elderly

The survival processing paradigm has recently drawn attention to the functional aspects of memory functioning. The survival effect, characterized by better memory performance when information is processed in a survival context, as compared with a variety of controls, is now well established in healthy populations. The main goal of this study was to test this paradigm in a group of cognitively impaired older adults and elderly; their data were compared to the data obtained in a group of healthy older adults and elderly. Seventeen cognitively impaired and 17 healthy participants performed a typical survival task using a blocked within‐subject design procedure and free recall as the memory test. The healthy older adults and elderly performed better on this memory task as well as on other tests included in a neuropsychological evaluation protocol. Importantly, both groups benefited from survival processing. These results provide further support for the power of survival processing, extending this phenomenon to cognitively impaired aging participants. The data also suggest that the survival effect is not simply a form of deep processing. Potential applied considerations are presented.     

You are Such a Bad Child! Appraisals as Mechanisms of Parental Negative and Positive Affect

Although parent cognitions are considered important predictors that determine specific emotional reactions and parental practices, models on the cognitive strategies for regulating parental distress or positive emotions are not well developed. Our aim was to investigate the nature of cognitions involved in parental distress and satisfaction, in terms of their specificity (parental or general) and their processing levels (inferential or evaluative cognitions). We hypothesized that parent's specific evaluative cognitions will mediate the impact of more general and inferential cognitive structures on their affective reactions. We used bootstrapping procedures in order to test the mediation models proposed. Results obtained show indeed that rather specific evaluative parental cognitions are mediating the relationship between general cognitions and parental distress. In terms of the cognitive processing levels, it seems that when parents hold both low self-efficacy and parental negative global evaluations for the self/child, this adds significantly to their distress.     

The Evolution of Mindfulness‐based Cognitive Therapy

Metcalf and Dimidjian (this issue) present a timely review of the evolving evidence base and mechanisms of mindfulness‐based cognitive therapy (MBCT). The present commentary extends the discussion on the current evidence base for MBCT based on findings from recent meta‐analytic reviews in this field which attest to the promising outcome for mindfulness‐based therapies, particularly for depressed populations. However, the specific effects of MBCT as applied to anxiety, health and developmental populations is still very much in its infancy. The second objective of this commentary extends discussion on the transdiagnostic applications of MBCT versus traditional cognitive behavioural therapy (CBT). It is recommended that with the continuing expansion of MBCT, the effects of this therapeutic approach needs to be evaluated against other empirically supported therapies, including traditional CBT.     

Depression Screening,Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists

Depression prevalence is between 15% and 20% in coronary heart disease patients, such as those with angina, or after a myocardial infarction or coronary artery bypass graft surgery. The presence of depression places a coronary heart disease patient at twofold higher risk for further major cardiac events and death, as well as poor quality of life and early exit from the labour force. As a consequence, several learned societies, including the National Heart Foundation of Australia, have published guidelines that recommend questionnaire screening to improve identification and management strategies for depression in coronary heart disease patients. Psychologists in hospitals, community settings, and private practice can have a key role in the realisation of the National Heart Foundation of Australia's aims. We review the recent guidelines and outline implications for psychologists to identify and manage depression in coronary heart disease patients. The evidence reviewed suggests that cognitive‐behavioural therapy and problem‐solving therapy are frontline non‐pharmacological interventions for depression in CHD patients.     

Individual differences in 10‐month‐olds' performance on the A‐not‐B task

This study used the classical A‐not‐B task (Piaget, 1954 ) to explore individual differences in cognitive flexibility in 10‐month‐old infants by: (1) examining how differences in search performance during A trials relate to search performance during B trials; (2) studying the relation between temperamental dimensions and A‐not‐B performance; and (3) investigating differences in search performance between looking and reaching responses within the same task. Forty infants were tested on a fixed‐design‐version of the A‐not‐B task, not allowing for training or individual adjustment, but instead eliciting additional search behaviors than the common correct responses in A trials and perseverative errors in B trials. Infants were also rated by their parents on the temperamental scales Activity level and Attention span. The main findings were: (1) performance on A trials affected B trial performance, with infants being more correct on A trials having more incorrect and less ‘no search’ responses on B trials; (2) activity level, but not attention span, was related to performance on the A‐not‐B task, with infants performing better on A trials having a lower activity level; and (3) there were a few differences in performance with regard to modality, indicating that responding correctly by looking may be less cognitively demanding than doing so by reaching. This study demonstrated that 10‐month‐olds show a wide variation of search behaviors on this A‐not‐B task, resulting in individual differences in performance. These differences are suggested to reflect variation in temperamental activity level as well as maturity of short term/working memory, inhibition and cognitive flexibility.     

A qualitative study of citizens' experience of participating in health counseling

Individual health counseling is a form of intervention designed to minimize the effects of chronic health disease and to offer a path towards good health practices. The aim of the present study was to explore the experiences of those persons who participated in health counseling in order to assess the psychosocial significance of the counseling upon their health behavior. In addition the study was concerned with the factors which underlay peoples' decision to sign up for health counseling. The research involved 11 semi‐structured interviews with individuals who had participated in a municipality based health counseling program. Data was analyzed using Malterud's systemic text condensation and a theoretical framework around Bandura's social cognitive theory. Analysis revealed that an approach tailored to each individual with minor short‐term goals accompanied by feeling supported by the counselor produced the greatest impact on behavior. Receiving feedback from the counselor and feeling positive about the relationship were seen as essential. These aspects were also crucial in the decision to undertake health counseling. The study indicates that whether individual's sign up on their own initiative or conversely are invited to join the program has no influence upon their motivation to change their behavior. Overall the respondents demonstrated improvement in their behavior and attitudes towards their health. However, the study also indicates that this form of intervention is less or even ineffective without the support of the individual's immediate family.     

RELIGION IS EASY,BUT SCIENCE IS HARD … UNDERSTANDING McCAULEY'S THESIS

Robert N. McCauley's new book Why Religion Is Natural and Science Is Not (2011) presents a new paradigm for investigating the relationship between science and religion by exploring the cognitive foundations of religious belief and scientific knowledge. McCauley's contention is that many of the differences and disagreements regarding religion and science are the product of distinct features of human cognition that process these two domains of knowledge very differently. McCauley's thesis provides valuable insights into this relationship while not necessarily leading to a dismissive view of theology or religious belief. His paradigm allows the research lens to focus on cognitive differences in processing scientific versus religious information and the important role of automatic, unconscious, and intuitive cognitive processes in understanding both the natural and supernatural worlds.     

DEFINING “RELIGION” AS NATURAL: A CRITICAL INVITATION TO ROBERT McCAULEY

Previous critics have argued that Robert McCauley defines religion and science selectively and arbitrarily, cutting them to fit his model in Why Religion Is Natural and Science Is Not. McCauley has responded that final definitions are “overrated” and that artificial distinctions can serve an important role in naturalistic investigation. I agree with this position but argue that a genealogy of the category of religion is crucial to the methodology that McCauley describes. Since the inherent ambiguity of religion will undermine any essential claims about its cognitive naturalness, I invite McCauley to consider how his research might investigate scientific and religious cognition in new terms.     

EXPLANATORY MODESTY

Although I certainly have differences with some of my commentators, I am grateful for the time, effort, and attention that each has devoted to my book, Why Religion Is Natural and Science Is Not. They have helpfully pointed out features of my positions that need clarification and elaboration. I am also grateful to the editor of Zygon, Willem Drees, for this opportunity to undertake that task here.