Understanding,respecting and integrating difference in therapeutic practice

The purpose of this paper is to promote thought and discussion around how and why we treat patients in chosen ways. In the present climate practitioners are required to treat patients following NICE guidelines in which cognitive behavioural therapy (CBT) is the treatment of choice in the majority of diagnoses. This paper raises concerns that this may lead to an homogenization of treatment, loss of invaluable skills and understanding from other treatment approaches, and loss to the patient who may be best cared for by a combination of treatments and approaches, most notably patients presenting with complex pathology. This paper aims to present this as a general principle, and by way of example, will focus on coupling two specific treatment orientations, cognitive behavioural therapy with psychodynamic psychotherapy, with the specific diagnosis of obsessive compulsive disorder (OCD).

Methods: Clinical material is drawn from case studies from practice in secondary adult mental health care services within the NHS. All patients were referred to the psychological services for treatment for OCD and provided with 1:1 therapy with UKCP‐registered therapists. Details have been anonymized by describing fictitious cases re‐constructed from clinical material. A theoretical understanding is included which provides both an overview for integrating treatment for the specific example of OCD and is intended by extension to other diagnoses.

Results: Working with the commonalities of therapeutic approaches, and integrating specific skills of CBT and psychodynamic psychotherapy, appears to offer a viable mode of treatment for cases resistant to single‐orientation therapies.

Conclusions: Coupling the skills of different therapies can be effective in treating complex patients that are referred to the secondary mental health services. Conversely, restricting practice to single orientation therapies can lead to an impoverished care for patients and diminution of invaluable therapeutic skills which may become underused, undervalued and lost in the practice of mental health care within the NHS. Acknowledgement of the skills of others, valuing these and learning from each other can help to avoid the defensive reactions of practitioners, where each may defensively retreat to their corners of specialism. Respecting and sharing skills from different orientations, and acknowledging this in the NICE guidelines, is good for both mental health services and patient care and addresses the concerns raised by practitioners exemplified by Bateman (2000 Bateman, A. 2000. Integration in psychotherapy: An evolving reality in personality disorder.. British Journal of Psychotherapy, 17(2): 147–156.  [Google Scholar], p. 147) that ‘psychotherapy continues to be bedeviled by ideological schisms with practitioners apparently ignoring alternative conceptualizations and potentially superior interventions’.     

Positive affect facilitates task switching in the dimensional change card sort task: Implications for the shifting aspect of executive function

Using the modified Dimensional Change Card Sort task, we examined the influence of positive affect on task switching by inspecting various markers for the costs, including restart cost, switch cost and mixing cost. Given that the executive-control processes that underlie switching performance—i.e., inhibition or shifting—are distinct from the component processes that underlie non-switching performance—i.e., stimulus evaluation, resource allocation or response execution—we hypothesised that if positive affect facilitates task switching via executive-control processes, rather than via component processes, positive affect would reduce both switch and restart costs, but not mixing cost, because both switch and restart costs rely on executive processes, while mixing cost imposes only minimal demands on executive processes. We found beneficial effects of positive affect on both restart and switch costs, but not on mixing costs. These results suggest that positive affect improves switching abilities via executive processes rather than via component processes.     

Overgeneral autobiographical memory predicts changes in depression in a community sample

This study investigated whether overgeneral autobiographical memory (OGM) predicts the course of symptoms of depression and anxiety in a community sample, after 5, 6, 12 and 18 months. Participants (N = 156) completed the Autobiographical Memory Test and the Depression Anxiety Stress Scales-21 (DASS-21) at baseline and were subsequently reassessed using the DASS-21 at four time points over a period of 18 months. Using latent growth curve modelling, we found that OGM was associated with a linear increase in depression. We were unable to detect changes over time in anxiety. OGM may be an important marker to identify people at risk for depression in the future, but more research is needed with anxiety.     

The role of cognitive appraisal in media-induced presence and emotions

In the present study, we applied Valins’ (1966) bogus bodily feedback paradigm to investigate the roles of cognitive appraisal (tele)presence, and emotion in the context of media usage. Participants (N=30) viewed short sequences of a TV show, whereby false heart rate feedback was provided. In line with Valins’ paradigm, the manipulation we used in this study included two levels: high vs. low false heart rate feedback. We assessed presence, enjoyment, and the real heart rate. Participants reported stronger experiences of presence and enjoyed the clips more when they wrongly believed that they had been aroused. Since bogus feedback increases the sensation of presence, the results indicate that presence—like emotions—can be influenced by cognitive appraisals. It is likely that the false heart rate feedback was attributed to the stimulus, which in turn enhanced the sensation of presence.     

Military Influence Tactics: Lessons Learned in Iraq and Afghanistan

When deployed U.S. soldiers attempt to influence the attitudes, beliefs, or behaviors of civilians, success can save lives and failure can be deadly. Survey data from 228 military personnel with deployment experience to Iraq and Afghanistan revealed that in a challenging wartime environment, empathy, respect, prior relationships, and familiarity with influence targets predicted success in cross-cultural influence attempts. Influence techniques involving resources and positive feelings were used more commonly in relatively successful influence attempts; negative tactics were used more commonly in unsuccessful attempts.     

Neuropsychological impairments on the NEPSY-II among children with FASD

Background: We examined the pattern of neuropsychological impairments of children with FASD (compared to controls) on NEPSY-II measures of attention and executive functioning, language, memory, visuospatial processing, and social perception.

Methods: Participants included 32 children with FASD and 30 typically developing control children, ranging in age from 6 to 16 years. Children were tested on the following subtests of the NEPSY-II: Attention and Executive Functioning (animal sorting, auditory attention/response set, and inhibition), Language (comprehension of instructions and speeded naming), Memory (memory for names/delayed memory for names), Visual-Spatial Processing (arrows), and Social Perception (theory of mind). Groups were compared using MANOVA.

Results: Children with FASD were impaired relative to controls on the following subtests: animal sorting, response set, inhibition (naming and switching conditions), comprehension of instructions, speeded naming, and memory for names total and delayed, but group differences were not significant on auditory attention, inhibition (inhibition condition), arrows, and theory of mind. Among the FASD group, IQ scores were not correlated with performance on the NEPSY-II subtests, and there were no significant differences between those with and without comorbid ADHD.

Conclusions: The NEPSY-II is an effective and useful tool for measuring a variety of neuropsychological impairments among children with FASD. Children with FASD displayed a pattern of results with impairments (relative to controls) on measures of executive functioning (set shifting, concept formation, and inhibition), language, and memory, and relative strengths on measures of basic attention, visual spatial processing, and social perception.     

A New Model for Acquiescence at the Interface of Psychometrics and Cognitive Psychology

ABSTRACT

When measuring psychological traits, one has to consider that respondents often show content-unrelated response behavior in answering questionnaires. To disentangle the target trait and two such response styles, extreme responding and midpoint responding, Böckenholt (2012a Böckenholt, U. (2012a). Modeling multiple response processes in judgment and choice. Psychological Methods, 17, 665–678. doi:10.1037/a0028111[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) developed an item response model based on a latent processing tree structure. We propose a theoretically motivated extension of this model to also measure acquiescence, the tendency to agree with both regular and reversed items. Substantively, our approach builds on multinomial processing tree (MPT) models that are used in cognitive psychology to disentangle qualitatively distinct processes. Accordingly, the new model for response styles assumes a mixture distribution of affirmative responses, which are either determined by the underlying target trait or by acquiescence. In order to estimate the model parameters, we rely on Bayesian hierarchical estimation of MPT models. In simulations, we show that the model provides unbiased estimates of response styles and the target trait, and we compare the new model and Böckenholt’s model in a recovery study. An empirical example from personality psychology is used for illustrative purposes.     

Mithraic iconography and ideology

L. Ron Hubbard created in Scientology an immense landscape of alternative worlds, realities, and possibilities. Scientology cosmology, mythology, and eschatology are inescapably linked to galactic events and Hubbard's retelling of human history is replete with science-fiction tropes – many of which found popularity in the early science-fiction tradition to which he belonged. In his therapeutic and religious teachings, Hubbard proposed a complex narrative that re-defined the essence of self and society in relation to the cosmos. For Scientologists, the fantastic becomes mundane as they position themselves within a vast and heavy quest to reshape themselves, the rest of humanity, and, for some, the entire universe. Understood within the science-fiction context from which Scientology emerged, one can better understand the grand nature of Hubbard's proposals as belonging to a specific tradition within the genre – namely, space opera. Consequently, this article analyses Hubbard's propositions using space-opera concepts, and argues that Hubbard re-defined a unique tradition in the course of creating a new reality.     

Visions as ‘Good to Think’: A Cognitive Approach to Visionary Experience in Islamic Sufi Thought

This article explores one type of visionary experience described and interpreted by mystics within certain traditions, which may be termed a ‘cognitive’ or ‘gnostic’ vision. Such visions provide information or offer solutions to problems of theology or religious interpretation.

A close textual analysis of a selection from the writings of an eighteenth century Indian Sufi, Shāh Wal? Allāh of Delhi, demonstrates this process of intensive thinking through superimposed grids which combine elements of religious symbol systems. This type of thinking triggers a mystical experience which is subsequently interpreted in a problem solving or divinatory mode.