Improving access to psychological therapies: systemic therapy in the Newham pilot site

The improving access to psychological therapies (IAPT) programme, which started with two pilot sites, has dramatically changed the provision of mental health services for depression and anxiety disorders in the National Health Service. The IAPT initiative has focused on the provision of cognitive behaviour therapy but incorporated a small systemic therapy service in the Newham pilot site. The outcomes of this systemic service are presented in this article. Most clients seen by the service suffered from depression and anxiety disorders. The response rate for the evaluation questionnaires was high. For the depression and anxiety measures the recovery rate was above 50 per cent and the effect sizes were large. Most of the clients were satisfied with the service. A trend towards employment was identified. The outcomes are discussed in comparison with those of the cognitive behaviour therapy service and recommendations for the process of further studies are made.     

A pilot study of a family‐focused intervention for children and families affected by maternal depression

A non‐experimental pilot study examined child, mother and family outcomes of a 10‐session multi‐family group intervention designed to reduce risk and promote resilience for mothers with depression and their families. Positive changes following the Keeping Families Strong intervention included mother‐reported decreases in child behaviour and emotional problems, improvements in the quality of family interactions and routines and improvements in their own well‐being and support from others. Children (9–16 years) reported decreased internalizing symptoms, improved coping, increased maternal warmth and acceptance and decreased stressful family events. Attendance and mother‐reported satisfaction were high, indicating the perceived value of the intervention.     

Rewarding performance feedback alters reported time of action

Past studies have shown that the perceived time of actions is retrospectively influenced by post-action events. The current study examined whether rewarding performance feedback (even when false) altered the reported time of action. In Experiment 1, participants performed a speeded button press task and received monetary reward for a presumed “fast,” or a monetary punishment for a presumed “slow” response. Rewarded trials resulted in the false perception that the response action occurred earlier than punished trials. In Experiments 2 and 3, the need for a speeded response and reward were independently manipulated in order to decouple the cognitive and reward components in the feedback signal. When tested independently, neither variable affected the judged time of action. We conclude that meaningful feedback (fast or slow) is only used when made salient by reward, to modulate the judged time of an action.     

Pre‐outcome regret: Widespread and overlooked

Many real‐life decisions (e.g. promises, plans and agreements) involve a time interval between when the decision is made and the main outcome is revealed. Nearly all regret studies focus on anticipated or experienced post‐outcome regret. We argue that regret is also frequently experienced in the pre‐outcome period, and that this ‘pre‐outcome regret’ has other sources than regret experienced after the outcome is known. Regret experienced in the pre‐outcome period has an important function post‐outcome regret (usually) cannot have, namely to motivate the decision maker to reconsider the ongoing decision process and reverse the initial decision. Pre‐outcome regret should for these reasons be distinguished from post‐outcome regret, and studied separately. In two scenario studies, participants were asked to imagine their regret after agreeing to perform an inconvenient task. In both, more regret was reported before than after the event, even when they had imagined a ‘worst case’ outcome. In the third study, participants described a difficult choice from their own life. Again, regret was perceived as higher in the pre‐outcome period than afterwards. In a fourth study, participants reported regret ‘online’ during an economic game (a version of the ultimatum game). They regretted their decisions more before than after they knew the outcome. We conclude that experienced pre‐outcome regret is often stronger than post‐outcome regret, and typically increases during the pre‐outcome period. We suspect that the absence of JDM studies of pre‐outcome regret is a legacy of the dominant gambling metaphor within decision research. Copyright © 2010 John Wiley & Sons, Ltd.     

心理咨询中的突然获益：工作同盟及初始症状的影响

对82位当事人在咨询中的症状改变过程进行纵向研究,检验突然获益模式（Sudden Gain, SG）的发生及其与咨询效果的联系,并探索初始症状水平、工作同盟对SG的影响。结果表明,24.93%的当事人经历了SG,咨询效果显著好于其他当事人;SG组与对照组在初始症状水平和总体工作同盟水平上差异显著。结论：SG出现于本土心理咨询中,经历SG的当事人取得了更好的咨询效果,工作同盟与初始症状水平与SG的发生相关。     

Developing an indicator of family function and a practicable outcome measure for systemic family and couple therapy: the SCORE

There is a need for a measure of outcome in systemic family and couples therapy (SFCT) that reflects current theory and practice. To meet the needs of SFCT practice the measure needs to use self‐report by family members, take a short time to complete and be easy to understand. The development of such a measure, called the SCORE, is reported in this article. Substantial piloting, consultation and review in terms of clinical judgement led to the construction of the SCORE 40 which has forty items about how the family functions, rated by family members over 11 years of age on a Likert scale, in addition to independent ratings of the family and its difficulties. The SCORE 40 is shown to be a viable instrument but is too substantial for everyday clinical use. In a research project to reduce and refine the measure and determine its psychometric properties the SCORE 40 was administered to 510 members of 228 families at the start of their first appointment for family therapy at clinics throughout the UK. The scale has good psychometric properties and could operate with either three or four dimensions. The analyses of these data, combined with data from a convenience sample of 126 non‐clinical families, allowed a reduction to fifteen items while retaining most of the information provided by the SCORE 40. This version is offered with three dimensions of: (1) Strengths and adaptability; (2) Overwhelmed by difficulties; and (3) Disrupted communication. It is hoped that the ready availability of the SCORE 15 will encourage routine evaluation of outcomes in clinics as well as the SCORE being used flexibly for both therapy and research.     

Anger management therapy with young male offenders: An evaluation of treatment outcome

The aim of the present study was to assess the effectiveness of a brief group‐based anger management intervention with young male offenders. Eighty‐seven prisoners were assessed as suitable for the intervention. Fifty of these made up the experimental group and 37 the control. Prior to intervention prisoners completed a self‐report anger questionnaire (Anger Management Assessment questionnaire: AMA). Prisoners were also assessed by officers on a checklist addressing angry behaviour (Wing Behaviour Checklist: WBC). Both measures were completed approximately two weeks before the date of the intervention and eight weeks after the intervention (and while the control group remained on the waiting list). It was predicted that the experimental group would show significant improvements in both measures following intervention and that no such change would be observed in the control group. This hypothesis was supported, with significant improvements observed in the experimental group and no change observed in the control. Aggr. Behav. 30:174–185, 2004. © 2004 Wiley‐Liss, Inc.     

Outcome of aggression affects processing and can legitimise subsequent aggression: Influence of trait aggressiveness

The present study investigated differences in processing times between positive and negative outcomes to an aggressive reaction to provocation. The effects of outcome, sex, trait aggressiveness and current mood on subsequent subject‐generated material were also examined. Fifty subjects read stories line by line on a computer screen. Reading time for the key sentence describing a positive or negative outcome to an aggressive reaction to provocation was recorded and subjects wrote a continuing sentence to half the stories. Subjects took less time to process the negative outcome. The positive outcome resulted in more subject‐generated aggression than the negative outcome. There were few sex differences but men wrote more aggressive endings than women for the stories containing physical aggression. Trait aggressiveness was correlated with producing more aggressive content in the continuing sentence for both outcomes. Feeling peaceful was correlated with producing prosocial material to neutral stories. Subjects therefore expect a negative outcome to aggressive behaviour. Reading stories which present a positive outcome to aggression increases the accessibility of aggressive cognitions. Subjects high in trait aggressiveness are not inhibited by a negative outcome. Aggr. Behav. 30:284–297, 2004. © 2004 Wiley‐Liss, Inc.     

The Adult Attachment Interview and psychoanalytic outcome studies

During the last two decades, the Adult Attachment Interview (AAI) has attracted growing interest from psychoanalysts concerned with empirical research. The paper discusses the application of Crittenden's Dynamic-Maturational AAI method for assessing the outcome of psychoanalysis. The aim is to demonstrate, through a case presentation, how therapeutic change can be expressed in the AAI. The pre- and post-treatment interviews of one patient, having completed a four-times-a-week psychoanalysis, are presented. It is demonstrated that the detailed discourse analysis of the AAI, based on transcribed tape-recorded interviews, focuses subtle formal elements of language and speech reflecting dominant patterns of affect regulation and object relating. The AAI text analysis provides possibility for coding procedural memory as conveyed by the handling of the relationship to the interviewer, incorporating the dynamic relationship between researcher and subject and thus complying with a methodological prerequisite regarded by many psychoanalysts as necessary for capturing data that are relevant to psychoanalysis. On this background, the method emerges as promising for psychoanalytic outcome studies.     

Locomotion, assessment, and regulatory fit: Value transfer from “how” to “what”

Regulatory fit is experienced when people pursue a goal in a manner that sustains their regulatory orientation. Previous research on promotion and prevention orientations has found that regulatory fit increases people’s perception that a decision they made was “right,” which in turn transfers value to the decision outcome, including being willing to pay more for a product than those who chose the same product without regulatory fit (Higgins, 2000; Higgins et al., in press). We predicted that the effect of regulatory fit on monetary value could be generalized to locomotion and assessment orientations. Participants were willing to pay over 40% more for the same book-light when it was chosen with a strategy that fit their regulatory orientation (assessment/“full evaluation”; locomotion/“progressive elimination”) than when it was chosen with a non-fit strategy.