Experimental and Behavioral Approaches to Alcoholism: Kongressrapport

Hypochondriasis is highly prevalent in medical settings, has detrimental effects for affected individuals, and is associated with high societal costs. Although cognitive behavior therapy (CBT) has been shown to be effective in the treatment of hypochondriasis, it is not widely available because of a lack of properly trained therapists. Therefore, it is essential to evaluate therapy forms that require less therapist time. The authors investigated the effect and economic impact of group CBT delivered in a psychiatric setting among 24 people with hypochondriasis. A within-group design with prolonged baseline was used, and all participants received 10 weeks of group-based treatment. The primary outcome measures were the Health Anxiety Inventory and the Illness Attitude Scales. Results indicate significant improvement on both measures at posttreatment and 6-month follow-up (Cohen's d = 1.03–1.72). Medical and nonmedical costs were substantially lowered. The authors conclude that group-based CBT delivered in a psychiatric setting is an effective and potentially highly cost-effective treatment for hypochondriasis.     

Disentangling the Impact of Resistance and Ambivalence on Therapy Outcomes in Cognitive Behavioural Therapy for Generalized Anxiety Disorder

Resistance and ambivalence about change are increasingly recognized as important determinants of treatment outcomes. Moreover, resistance and ambivalence are thought to be theoretically related in that clients who are more ambivalent about change are more likely to demonstrate resistance to the process and tasks of treatment. In the context of cognitive behavioural therapy (CBT) for generalized anxiety disorder, the present study simultaneously examined early resistance and ambivalence using two observer-based coding systems in order to determine their inter-relationship and, importantly, to investigate their relative contributions to outcome. Resistance was also coded during mid-treatment in order to investigate possible mediation pathways. Early ambivalence (clients’ arguments against change or counter-change talk) was found to be no longer related to outcomes when early resistance was taken into account, suggesting that disharmony in the therapeutic relationship is more important to outcomes than ambivalence per se. Moreover, mid-treatment resistance partially mediated the relationship between early resistance and post-treatment worry severity. That is, higher early opposition to therapist direction is related to poorer outcomes, in part because it is associated with greater resistance during the working phase of CBT. The findings underscore the critical need for therapists to be sensitive to identifying resistance early and throughout treatment.     

择偶与人类嗓音

本文对择偶与人类嗓音之间的关系进行了深入分析。首先, 人类具有普遍的异性嗓音偏好：男性偏爱高音调的女性嗓音, 女性偏爱低音调的男性嗓音, 这种普遍偏好受到一系列跟自身婚配价值有关的因素的调节。其次, 人类的嗓音偏好跟嗓音背后的进化意义密切关联：女性化嗓音是女性生育力的线索, 而男性化嗓音是男性好基因和好资源的线索。而且, 富有吸引力的男性嗓音和女性嗓音能够预测个体的性行为和繁殖成功。再次, 富有有吸引力的人类嗓音影响个体的社会认知, 对亲密关系的维系也会带来消极影响。最后, 我们探讨了未来研究的若干方向：研究基频之外的其他嗓音参数, 探讨嗓音偏好的性选择机制、特殊群体的嗓音偏好, 以及嗓音偏好与其他认知过程的关系。     

From Resistance to Buy-In: Experiences of Clinicians in Training Using Feedback-Informed Treatment

In this qualitative research study, the authors use grounded theory analysis to examine the experiences of clinicians in training and use client feedback to inform treatment. Twenty-six marriage and family therapy graduate students in their first or second semester of clinical practicum participated in this study. Participants were trained in eliciting and responding to client feedback at the end of every therapy session. At the end of the semester, participants reflected on their learning experience. Participant experiences reflected a developmental learning process beginning with significant challenges followed by positive clinical changes and positive clinician changes, culminating in overall buy-in regarding the importance of client feedback for nearly all clinicians. The results support the literature that client feedback directly informs the therapeutic process while suggesting important recommendations for training new clinicians in learning to use client feedback.     

Evaluating the Effects of Creative Journal Arts Therapy for Survivors of Domestic Violence

The authors implemented a small series (N = 3) single-case research design to assess the effectiveness of a 9-session creative arts therapy treatment program for adult survivors of domestic violence. Analysis of participants’ scores on the Outcome Questionnaire (OQ-45.2) and Brief Resilience Scale using the percentage of nonoverlapping data procedure yielded treatment effects indicating that a creative arts therapy treatment program may be effective for reducing mental health symptoms and improving resiliency. It is recommended that this body of research continue for other educational, work, and health settings.     

Observed Attachment and Self-Report Affect Within Romantic Relationships

Adult attachment provides unique insights that help researchers and clinicians understand the complexities of individuals and relationships. In romantic relationships, individual attachment can explain partners' abilities for closeness and autonomy as well as how they experience affect within the relationship. These affective experiences during couple interactions have been shown to influence both proximal and distal relationship outcomes. Thus, the authors explore the impact of partners' observed attachment behaviors—coded using the AABQ—on continuous reports of their affective experiences during both difficult and positive marital conversations. Variables examining couple affective negativity and flexibility were developed using state space grids, and data were analyzed using GridWare. Results showed that observed female attachment behaviors significantly impacted a couple's affective experiences of negativity and flexibility during conversations, while there were no significant associations between male observed attachment behaviors and the couple affective experience. Clinical implications and suggestions for future research are discussed.     

Expanding the evidence: Developments and innovations in clinical practice,training and competency within voice and communication therapy for trans and gender diverse people

Background: Speech and language therapists (SLTs) deliver voice and communication therapy for trans and gender diverse people to facilitate authentic vocal and communicative expression. Davies, Papp, and Antoni (2015) have provided a comprehensive review of the literature, with recommendations for good clinical care. Several areas highlighted as gaps in the research were identified by the current authors as ones in which evidence is expanding.

Aims: To demonstrate 1) an expansion of the evidence base in particular innovations in voice group therapy for trans women and trans men; 2) the importance of delivering voice and communication therapy as part of a complete approach to trans and gender diverse health care; and (3) developments in training and competency in the UK.

Method: Data were drawn from three small-scale projects, two surveys, and one audit.

Measurements: Data from survey and audits and pre- and post-group acoustic measures of and client self-perceptual measures, including the Transsexual Voice Questionnaire (TVQ^MtF); a client-generated set of questions for trans men; and the migration of vocal identity map, adapted from Narrative Therapy practices.

Results: Positive outcomes for both pitch measures and client perception were recorded. Audit and survey data provided evidence of developments in training and competency in the UK.

Conclusion: Evidence supports group therapy as a successful approach for trans individuals across a number of parameters of voice and self-perception. Voice group protocols for both trans men and trans women should take account of the social context within which to explore relational presence and authentic voice. SLTs within gender identity clinics provide voice and communication as part of a broader pathway of care, alongside sharing professional knowledge and skills. Current UK developments are documented as indicators of positive responses to the growth in the number of SLTs seeking to develop specialist skills within this field.     

Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials

Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges’ g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g = .82, 95% CI: .58–1.05, depression: g = .79, 95% CI: .59–1.00) and medium on quality of life (g = .56, 95% CI: .37–.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.     

Improving executive function using transcranial infrared laser stimulation

Transcranial infrared laser stimulation is a new non‐invasive form of low‐level light therapy that may have a wide range of neuropsychological applications. It entails using low‐power and high‐energy‐density infrared light from lasers to increase metabolic energy. Preclinical work showed that this intervention can increase cortical metabolic energy, thereby improving frontal cortex‐based memory function in rats. Barrett and Gonzalez‐Lima (2013, Neuroscience, 230, 13) discovered that transcranial laser stimulation can enhance sustained attention and short‐term memory in humans. We extend this line of work to executive function. Specifically, we ask whether transcranial laser stimulation enhances performance in the Wisconsin Card Sorting Task that is considered the gold standard of executive function and is compromised in normal ageing and a number of neuropsychological disorders. We used a laser of a specific wavelength (1,064 nm) that photostimulates cytochrome oxidase – the enzyme catalysing oxygen consumption for metabolic energy production. Increased cytochrome oxidase activity is considered the primary mechanism of action of this intervention. Participants who received laser treatment made fewer errors and showed improved set‐shifting ability relative to placebo controls. These results suggest that transcranial laser stimulation improves executive function and may have exciting potential for treating or preventing deficits resulting from neuropsychological disorders or normal ageing.