The implementation of routine outcome measures in a Tier 3 Psychological Therapies Service: The process of enhancing data quality and reflections of implementation challenges

Background: The Newham Psychological Therapies Service (PTS) has been using the CORE System of evaluation to demonstrate effectiveness since 2004. More recently there has been the national and local drive to improve outcomes as outlined by a number of Department of Health policies and the Improving Access to Psychological Therapies (IAPT) initiative. Aims: This paper describes how, as a secondary care complex mental health service, we have engaged with the process of outcome measurement through complementing the usage of the CORE System with additional measures forming the service pilot minimum dataset. The process of implementation is outlined along with reflections on the challenges which the service faced in introducing outcome measurement. Findings: Engagement with outcome measurement by a service requires attention to be paid to the organisational and professional aspects and personal resonances for clinicians if it is to become established as a meaningful enterprise within secondary care services. Despite success at this task, challenges remain to the further development of this area of work.     

Stopping dead in one’s tracks: Motor inhibition following incidental evaluations

Motivational theories of affect contend that negative stimuli should slow motor behavior. However, this claim has been supported mainly by animal research. The current investigation establishes, perhaps for the first time, that incidental negative primes slow subsequent motor behavior among humans. In addition to examining choice reaction time (Studies 1 and 2), we introduce a method for examining the speed of continuous motor behavior (Study 3). In all studies, we found that behavior was slowed following, or in the context of, negative stimuli. It is concluded that, in certain situations, the mere presence of negative stimuli inhibits the speed of subsequent motor behavior.     

The surprisingly low motivational power of future rewards: Comparing conventional money-based measures of discounting with motivation-based measures

Temporal discount rates are often poor predictors of behaviors that we expect will be motivated by the future. The current research suggests this may be because conventional discounting measures are poor measures of the motivational value of future rewards. In six studies, I develop motivation-based measures of the present value (PV) of future rewards and compare the PVs obtained with those obtained using conventional money-based discounting measures. Conventional money-based PVs consistently overestimate motivation-based PVs and are discriminable from them. I explore explanations for this mismatch, including timing of effort exertion (Study 2) and loss aversion (Study 3), both features of the motivation-based measures. In Study 5, I use self-reports of valuation strategies and a time pressure manipulation to demonstrate that participants use different valuation strategies in the conventional money-based and the motivation-based measures that, in part, determine the difference in PVs obtained and the relatively low correspondence between them.     

Local communities responding to ecological challenges—A psycho‐social approach to the Natura 2000 Network

The institutionalization of biodiversity conservation through legal instruments has led to mixed reactions at both the individual and community levels, with conflict and resistance co‐existing with support. The overall purpose of this paper is to describe how rural communities living in areas included in the Natura 2000 Network of protected sites, where local practices of land use are regulated by new legal directives, receive biodiversity conservation goals. Previous studies suggest that this reception is strongly shaped by place identification, but their contradictory results demand further clarification. This study examines the role of psycho‐social variables identified by previous studies as potentially relevant moderators of identification: (a) Vested interest in natural resources, (b) evaluation of the designation process of protected areas and (c) institutional trust. It further extends previous research by analysing the support given to contextually relevant ecological practices. Results reveal a positive link between place identification and attitudes in the high vested interest condition and show that support for conservation practices is better predicted in the high vested interest and low trust conditions. The discussion focuses on the relevance of analysing contextually relevant psycho‐social moderators when attempting to understand how local communities' relation with biodiversity conservation is affected by legislative innovation. Copyright © 2009 John Wiley & Sons, Ltd.     

The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD

This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dissociation, numbing, and depersonalization) were assessed at pretreatment using semi-structured interviews and questionnaires. In a pretreatment behavioral exposure test, patients were imaginally exposed to (part of) their trauma memory for 9 min, during which subjective fear was assessed. At posttreatment and 6 months follow-up PTSD, depressive and dissociative symptoms were again assessed in the completers (n = 60). Pretreatment levels of dissociative and depressive symptoms were similar in dropouts and completers and none of the dissociative phenomena nor depression predicted improvement. Against expectations, dissociative phenomena and depression were associated with enhanced rather than impeded fear activation during the behavioral exposure test. However, these effects disappeared after controlling for initial PTSD severity. Hence, rather than supporting contraindication, the current results imply that patients presenting with even severe dissociative or depressive symptoms may profit similarly from exposure treatment as do patients with minimal dissociative or depressive symptoms.     

Prior sensitivity in theory testing: An apologia for the Bayes factor

A commonly voiced concern with the Bayes factor is that, unlike many other Bayesian and non-Bayesian quantitative measures of model evaluation, it is highly sensitive to the parameter prior. This paper argues that, when dealing with psychological models that are quantitatively instantiated theories, being sensitive to the prior is an attractive feature of a model evaluation measure. This assertion follows from the observation that in psychological models parameters are not completely unknown, but correspond to psychological variables about which theory often exists. This theory can be formally captured in the prior range and prior distribution of the parameters, indicating which parameter values are allowed, likely, unlikely and forbidden. Because the prior is a vehicle for expressing psychological theory, it should, like the model equation, be considered as an integral part of the model. It is argued that the combined practice of building models using informative priors, and evaluating models using prior sensitive measures advances knowledge.     

The rise of chatbots: The effect of using chatbot agents on consumers' responses to request rejection

This research investigates consumers’ perceptions and evaluations of robot service agents compared with human service agents when service requests are rejected. Six studies were conducted. The results show that when consumers receive a rejection of their service request, they evaluate the service less negatively if the service is handled by a chatbot agent versus a human agent. The reason is that consumers have lower expectations that robots will be able to provide flexible services to them. Consequently, their dissatisfaction with the request rejection is lower when the service is handled by robots. However, the aforementioned effect is not observed (1) when consumers have not experienced the service yet, (2) when their service request has been accepted, or (3) when the service agent conveys emotions to apologize for request rejection.     

家庭医生获得感概念框架及评价模型的构建

通过文献综述和专家咨询的方法构建家庭医生获得感概念框架和评价模型。研究将家庭医生获得感界定为在家庭医生签约服务制度下,家庭医生基于客观获得而产生的主观情绪体验和情感反应的综合感受,构建以获得内容、获得体验、获得途径、获得环境、获得共享五个维度的家庭医生获得感概念框架,并结合相关获得感研究编制家庭医生获得感评价模型,包括5个一级指标、13个二级指标、39个三级指标,为家庭医生获得感研究提供参考。