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.     

Individual response differences in spider phobia: Comparing phobic and non-phobic women of different reactivity levels

Abstract

In contrast to previous stress research, studies concerning phobic disorders have never systematically investigated individual response differences between phobic participants integrating numerous different response measures. The aim of this article is to clarify the existence of significant individual response differences in psychophysiological responses (e.g., heart rate, skin conductance responses (SCR), corrugator, cortisol), subjective ratings (e.g., valence, arousal), and avoidance behavior in 46 spider phobic and 44 non-phobic women when exposed to 20 phobic and 20 neutral pictures. Previous studies that did not attend to individual response differences showed that, during phobic stimulation, phobic individuals have increased psychophysiological responses (heart rate, SCR, and corrugator responses), more negative valence rating, and more subjective arousal than non-phobic individuals. These results were confirmed by our data. With regard to individual response uniqueness, 1/3–2/3 of spider-phobic women with low responsiveness in heart rate, cortisol, and avoidance behavior were indistinguishable from non-phobic women during phobic stimulation. With SCR, corrugator EMG, and subjective ratings, no individual response uniqueness was found. Based on the findings, exposure therapy might be improved by tailoring interventions to individuals with a therapeutic focus on those psychophysiological measures that show the highest individual responsivity.     

An Historical Overview of Basic Approaches and Issues in Ethical and Moral Philosophy and Principles

Summary

This article provides a condensed history of ethics development for the purpose of exposing psychologists and other mental health professionals to ethical and moral bases upon which modern psychological ethics are founded. In addition, it focuses on contemporary theories, with an emphasis on professional ethics.     

An Attributional Perspective on Sexual Aggression in India

ABSTRACT

This article reports the findings of programmatic research on attributions made by Indian participants with respect to hypothetical incidents of sexual aggression. The Indian research findings in the context of related research in Western countries, especially the judgmental variations obtained as a function of rapist-victim acquaintance and participant's gender, reflect the relatively low status of women and the patriarchal dominance of men in Indian society. Among other issues examined in the reviewed experiments were the rape victim's causal versus moral responsibility, the rapist-victim relationship, the gender-adversary perspective, and the ambiguity about victim's consent.     

The alluringness of desire

In her book, Unprincipled Virtue, Nomy Arpaly is suspicious of reflective endorsement or deliberative rationality views of agency, those which tie the possibility of responsibility and moral blame to the conscious exercise of deliberation and reflection, and which require as a condition of blame- or praise- worthiness an agent's explicit commitment to ethical principles. I am in sympathy with her attack on standard autonomy theories, but argue that she confuses the phenomenon of unknowing and unreflective responsiveness to the right-making features of an action with incomplete and merely provisional commitment to principles and maxims of action, and argue that she is often arguing against straw men. I also argue that she has misinterpreted the fascinating literary examples she adduces to make her case.     

Alternative motivation: a new challenge to moral judgment internalism

Internalists argue that there is a necessary connection between motivation and moral judgment. The examination of cases plays an important role in philosophical debate about internalism. This debate has focused on cases concerning the failure to act in accordance with a moral judgment, for one reason or another. I call these failure cases. I argue that a different sort of case is also relevant to this debate. This sort of case is characterized by (1) moral judgment and (2) behavior that accords with the content of the moral judgment but that has been performed not because of the moral judgment. Instead it is due to some other source of motivation. I call these alternative motivation cases. I distinguish two sorts of alternative motivation cases, and I argue that externalists have natural explanations of these cases. By contrast, extant internalist accounts of failure cases are inadequate when applied to alternative motivation cases.     

Confounds in moral/conventional studies

In ‘The nature of moral judgments and the extent of the moral domain’, Fraser (2012 Fraser, B. 2012. “The nature of moral judgements and the extent of the moral domain.” Philosophical Explorations 15 (1): 1–16. doi:10.1080/13869795.2012.647356.[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) criticises findings by Kelly et al. (2007 Kelly, D., S. Stich, K. J. Haley, S. J. Eng, and D. M. T. Fessler. 2007. “Harm, Affect, and the Moral/Conventional Distinction.” Mind & Language 22 (2): 117–131. doi: 10.1111/j.1468-0017.2007.00302.x[Crossref], [Web of Science ®] , [Google Scholar]) that speak against the moral/conventional (M/C) distinction, arguing that the experiment was confounded. First, we note that the results of that experiment held up when confounds were removed (Quintelier, Fessler, and De Smet 2012 Quintelier, K. J. P., D. M. T. Fessler, and D. De Smet. 2012. “The Case of the Drunken Sailor: On the Generalizable Wrongness of Harmful Transgressions.” Thinking & Reasoning 18 (2): 183–195. doi:10.1080/13546783.2012.669738.[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). Second, and more importantly, we argue that attempts to prove the existence of a M/C distinction are systematically confounded. In contrast to Fraser, we refer to data that support our view. We highlight the implications for the moral/conventional theory.     

Blame,desert and compatibilist capacity: a diachronic account of moderateness in regards to reasons-responsiveness

This paper argues that John Fischer and Mark Ravizza's compatibilist theory of moral responsibility cannot justify reactive attitudes like blame and desert-based practices like retributive punishment. The problem with their account, I argue, is that their analysis of moderateness in regards to reasons-responsiveness has the wrong normative features. However, I propose an alternative account of what it means for a mechanism to be moderately reasons-responsive which addresses this deficiency. In a nut shell, while Fischer and Ravizza test for moderate reasons-responsiveness by checking how a mechanism behaves in a given time slice across other possible worlds, on my account we should ask how that mechanism behaves in this world over a span of time – specifically, whether it responds to reasons sufficiently often. My diachronic account is intended as a drop-in replacement for Fischer and Ravizza's synchronic account.     

Praise and prevention

I argue that it is possible to prevent (and to be praiseworthy for preventing) an unwelcome outcome that had no chance of occurring. I motivate this position by constructing examples in which it makes sense to explain the non-occurrence of a certain outcome by referring to a particular agent's intentional and willing behavior, and yet the non-occurrence of the outcome in question was ensured by factors external to the agent. I conclude that even if the non-occurrence of an unwelcome outcome is ensured, the agent whose action explains this non-occurrence is praiseworthy for preventing the outcome. My examples are similar in important respects to Frankfurt-type cases. In the second half of the paper, I discuss the relationship between my examples and Frankfurt-type cases involving both actions and omissions. I conclude that while I may be responsible for the consequences of an action even if those consequences are unavoidable, this is not necessarily so for the consequences of omissions.     

Merit,fit, and basic desert

Basic desert is central to the dispute between compatibilists and incompatibilists over the four-case manipulation argument. I argue that there are two distinct ways of understanding the desert salient to moral responsibility; moral desert can be understood as a claim about fitting responses to an agent or as a claim about the merit of the agent. Failing to recognize this distinction has contributed to a stalemate between both sides. I suggest that recognizing these distinct approaches to moral desert will help clarify a central source of disagreement between compatibilists and incompatibilists and assist both sides in resolving the current stalemate.