The relationship between psychoanalysis and schizophrenia-A response to the commentary by Robert Michels

In this section, the author responds to Dr Michels's commentary. In contrast to the situation in the United States, there are far fewer psychoanalysts in the UK and very few indeed working in general psychiatry to influence its practice. It is argued that psychoanalysis differs from all other psychological approaches with its recognition of the inner world and its unconscious influence on the individual's everyday life. Michels invites one to focus on outcome studies to judge the effectiveness of psychoanalysis in schizophrenia. There is a danger of throwing the baby out with the bathwater in that psychoanalysis helps in understanding presenting clinical material and in risk assessment in everyday general psychiatry.     

Introduction to the Special Section: Advances in psychological prevention and treatment interventions to promote children's mental health

This paper introduces the Special Section on Advances in Psychological Prevention and Treatment Interventions to Promote Children's Mental Health. The three articles in the Special Section provide perspectives on the adaptation, evaluation, and implementation of evidence‐based psychological interventions for children in countries in Northern and Eastern Europe, and Latin America. The articles highlight disparate methodologies for the examination of intervention data, including addressing causal inference in the absence of availability of true experiment data (i.e., randomised controlled trial data), randomised trial data from a school‐based prevention programme, and predictors of change in an evidence‐based treatment programme. Together, the articles highlight the movement of evidence‐based practices into routine care settings and emerging strategies for settings in which randomised trial data are not yet available. They demonstrate the contribution of psychological research to the advancement of practices for improving children's mental health.     

部分中文医药杂志伦理保护措施的报告情况

对2002年之前和之后(2000年7月~2001年12月和2003年1月~2004年6月)对6种中文医药杂志发表的临床研究类文章进行比较,并对文中报告知情同意和伦理委员会批准情况的比例给予评价。     

Testing the benefits of expressive writing for workplace embitterment: a randomized control trial

Clinicians working in occupational health services often recognize features of embitterment in organizations; however, research on interventions for embitterment are scarce. The present study aimed to assess the effectiveness of an expressive writing intervention on working adults who experience workplace embitterment. Employing a randomized control trial we sought to test an expressive writing intervention for its effects on reducing embitterment, work-related rumination and sleep quality and assess whether the effect of the intervention was maintained over time by following up participants after one and three months. Findings partially supported our hypothesis as results showed that participants who completed the expressive writing intervention (N = 23) did not show significantly lower levels of embitterment, affective rumination, higher levels of detachment, either improved sleep quality, compared to participants who completed the factual writing (N = 21), when baseline values were controlled for. However, when looking at the mean scores embitterment and affective rumination levels diminished, detachment levels increased and sleep quality improved throughout the course of the intervention for both groups. Given the stability of embitterment and as findings from this study indicate embitterment diminished after a writing exercise irrespective of emotional disclosure taking place or not, further research and investigation are warranted.     

Using Technology to Deliver Immediate Corrective Feedback to Preservice Teachers

Teacher preparation programs are under scrutiny for their role in the troubled American educational system. If American education is to improve, teacher educators must identify and encourage teachers to use effective teaching practices. A promising technique for increasing use of teaching practices is providing feedback to teachers on newly acquired behaviors. The focus of this study was to examine the effects of immediate corrective feedback on one specific teaching behavior, use of three-term contingencies, to preservice teachers. A multiple baseline design across participants was used to evaluate the effects of immediate corrective feedback, delivered via a wireless FM listening system. Immediate corrective feedback (as compared with delayed feedback) was shown to be an effective way to increase preservice teacher completion of three-term contingency trials by all participants. These findings and other considerations for additional research using feedback are addressed.     

Ethical and social dilemmas in community-based controlled trials in situations of poverty: a view from a South African project

All psychological and social research presents ethical dilemmas, many of which centre around the difficulties which flow from the power imbalances between those conducting the research and the research respondents or participants. Issues of power are magnified in research undertaken in contexts of poverty, and there is a burgeoning literature on ethical issues in research in developing countries. In this article, we augment the existing literature by focusing on the experiences of an assessor working in a controlled trial of a mother-infant intervention in a poor South African community. We consider issues of community expectations, the presentation to our project of physical health problems, the issue of HIV/AIDS, cultural beliefs which impact on the research, child protection issues, and the tensions between research assessment and ubuntu--a cultural norm which requires helpful engagement with others. We suggest that our experiences may assist with the development of further research.     

What does the public think of placebo use? The Canadian experience

Part of the National Placebo Initiative in Canada included public consultations, based on the belief that the views of the public should inform Canadian policy development on what constitutes appropriate placebo use. Public consultations took place nationally in 2003. A deliberative dialogue approach was used, or a structured discussion format designed to facilitate the consideration of complex issues and build consensus. The placebo debate was characterized as having 3 distinct approaches and each were explored. The first approach “Maximize Patient Protection” identified the need for experts to determine appropriate placebo use and that placebos should only be allowed under very restricted conditions. The second approach “Maximize Medical Knowledge” identified that placebos give essential information about the safety and efficacy of new drugs, and are appropriate when the rights, safety and well-being of research participants are ensured. The third approach “Maximize Patient Autonomy” identified that the current system of regulating placebo use is paternalistic and that patients should be able to define what is in their best interests and have more leeway to determine for themselves if they wish to participate in a placebo-controlled trial. Advantages and disadvantages of each approach were considered and feedback on what constitutes appropriate placebo use was sought. The major findings were that: PCTs were considered a valuable and acceptable part of advancing medical knowledge; research using placebos must be valid and justifiable; a patient-centred approach needs to be fostered; patient autonomy (choice) should be a first consideration and take clear precedence in trials of low to medium risk; patient protection (or health) may need to “trump” patient autonomy at higher levels of risk and/or patient vulnerability; placebos are not a violation of the duty of care as duty of care is best met by identifying a choice for patients, whenever a choice is available. These consultations clearly were not designed to produce conclusive evidence, but rather to provide some useful insights into what the public may think about placebo use; additional studies are indicated. Funding for the public consultations was provided by Health Canada and the Canadian Institutes of Health Research. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Placebos and the UK medical research council — and the consumer perspective

The UK Medical Research Council, in order to further its mission of maintaining and improving human health, supports a substantial number of clinical trials on a wide variety of medical questions; some of these trials involve the use of placebos as controls or to maintain blinding. Before providing support, proposed trials are carefully reviewed to assess scientific quality, and to determine whether a placebo is required and is ethical — in addition to ethics review by independent Research Ethics Committees. Some questions such as the choice of placebos in trials in developing countries, in surgical trials and those involving alternative medicine require consideration of additional, specific issues. Involvement of consumers in MRC work has been increasing and includes the establishment of a Consumer Liaison Group; members of this group comment on patient information leaflets for clinical trials, helping to improve patient understanding of trials and ensuring topics like placebo use are explained clearly. Views differ on the value of placebos in clinical care and on their mechanism of action; continuing research is helping to clarify the issues. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Commentary: Prevention/Intervention Trials and Developmental Theory: Commentary on the Fast Track Special Section

Well-conducted prevention and intervention research has the potential to serve the dual ends of enhancing children's adaptive outcomes and elucidating important developmental processes and mechanisms related to change. Admirably, the Fast Track preventive intervention was conceived in accord with explicit developmental theory related to the development of conduct problems. Herein, I consider how the present reports of grade-3 outcomes allow examination of causal processes and developmental mechanisms related to the effects uncovered, featuring the constructs of prediction, moderation, and particularly mediation. The multifaceted, intensive nature of the Fast Track preventive intervention is at once a clinical strength and a liability in terms of isolating causal processes underlying child change. I also consider issues related to the random assignment of the investigation and to policies that may emerge from the findings. In all, research that aims to identify relevant developmental and causal processes must incorporate both experimental and nonexperimental paradigms that are conceptualized from the outset with explanatory purposes in mind.