One of the troubles with outcome measures: Lost in translation

This paper presents the concerns of a client diagnosed with autism spectrum disorder about completing outcome measures. He was asked to complete CORE‐10 each time he attended a therapy session with the first author. This paper takes an epistemological position of co‐production, and written in response to the client's concerns, but this is limited by the client's wish and capacity to be involved in the writing up of this article. Implications of his experiences are drawn out for both clients with this diagnosis and more generally for all clients. Recommendations are made to recognise the limitations of measures and how to use outcome measures with more validity.     

Tobacco Use Predicts Treatment Dropout and Outcome in an Acute,Transdiagnostic Psychiatric Treatment Setting

Tobacco use is consistently associated with greater levels of depression and anxiety, broadly, and preliminary evidence suggests that current tobacco use is a significant predictor of dropout from psychiatric treatment. The current study extends past work to examine the impact of tobacco use on treatment dropout and outcomes in an acute psychiatric treatment setting. Upon intake to a partial hospitalization program (PHP), patients completed a battery of measures assessing sociodemographic characteristics, current tobacco use, depression and generalized anxiety, and substance use. Patients at the PHP also completed measures assessing levels of depression and generalized anxiety again upon discharge from the program. In line with hypotheses, current tobacco use was a significant predictor of dropout from treatment at the PHP. Importantly, this relationship remained significant when statistically controlling for demographic variables and psychiatric and substance use severity (such as number of previous inpatient psychiatric hospitalizations and degree of alcohol or drug problems). Results from the current study indicate that tobacco use is a significant risk factor for treatment dropout. Further research is needed to replicate these findings and to determine the mechanism underlying this link between tobacco use and treatment dropout for people receiving intensive psychiatric care.     

Neurocognitive outcomes in children with unilateral basal ganglia arterial ischemic stroke and secondary hemidystonia

Dystonia is a movement disorder that involves excessive, involuntary muscle contractions resulting in repetitive movements and/or abnormal posturing. One common cause of unilateral dystonia in childhood is ischemic stroke involving the basal ganglia and/or thalamus. Virtually nothing is known about neuropsychological outcomes in children who have dystonia following basal ganglia stroke. The present study explored whether or not children with secondary dystonia experience additional cognitive challenges when compared to children with similar patterns of brain injury, but no dystonia. We examined intellectual function, academics, and several aspects of executive function in children with unilateral basal ganglia stroke during childhood, comparing those with dystonia and those without. Although groups did not differ in terms of lesion size, we found significantly lower performance on measures of verbal and nonverbal reasoning, inhibitory control, and academic ability in children with secondary dystonia compared to those without. In contrast, there were no significant group differences on parent ratings of their child’s executive function in daily life. These findings suggest that maladaptive reorganization following basal ganglia stroke may contribute to the development of secondary dystonia and also to poor intellectual and academic outcomes in this group.     

Challenges to addressing student mental health in embedded counselling services: a survey of UK higher and further education institutions

With reports continually demonstrating increased demand and severity of student mental health needs, it is important to gain a fuller understanding of the impact on embedded student counselling services. The aims of this research were to identify (a) service similarities, (b) factors which impact on services, (c) characteristics of service users, and (d) the use of therapeutic technology (e.g. online self-help). An online survey was completed by 113 heads of UK student counselling services across Higher Education (HE), Further Education (FE), and Sixth Form Colleges (SFCs), to capture service data from the academic year 2013/14. Students predominantly received high-intensity support (e.g. counselling) and referrals increased over 3 years. Challenges to embedded counselling services and their implications for development are discussed.     

Better Safe than Sorry: Risking Irresponsibility by Seeking Uncertainty

Research findings differ as to whether choosing a risky option is an efficient strategy for decision makers seeking to avoid responsibility for potential failures. A risky choice may leave the final outcome to chance factors, but the decision maker can still be held responsible for choosing risk. Further, it is unclear whether a risky choice is a responsible choice. The present article investigates the putative relationship between risk‐taking and responsibility by drawing a distinction between being responsible for the outcome (R1) versus acting responsibly (R2). Four experiments were performed, in which participants were presented with scenarios describing decision makers facing a choice between a risky (uncertain) option and a riskless (certain) option, framed in terms of losses or equivalent gains. The results showed that decision makers who chose the risky alternative were judged to have acted in a less responsible manner (R2), while still being held equally responsible for the outcome (R1), unless they were ignorant of the risks involved. Choosing risk did not absolve decision makers from blame, despite being less causal and less in control than those who chose the riskless option. Risky decision makers were also judged to be more personally involved. The dissociation between R1 and R2 ratings confirms earlier findings and serves to clarify an alleged relationship between risky choices and responsibility aversion. Framing effects for own choices were found in both scenarios. In contrast, responsibility ratings were only slightly affected by frame. Copyright © 2017 John Wiley & Sons, Ltd.     

Rupture Repair

A strong therapeutic relationship provides the optimal context for CBT, and an important component of this relationship is the alliance. An alliance rupture is a difficulty or deterioration in the alliance manifested by a lack of collaboration on therapy tasks or goals or a strain in the bond. The process of rupture repair can facilitate the work of therapy by renewing collaboration and strengthening the bond. Rupture repair can also provide the opportunity for a corrective experience of successfully navigating interpersonal conflict. A review of research on rupture repair in CBT treatments highlights that ruptures are common, and that failure to repair ruptures is associated with poor outcome and premature dropout. Therapists can reduce the likelihood of contributing to ruptures by adhering to the principle of collaborative empiricism. Therapists can facilitate rupture repair by recognizing ruptures when they occur and employing repair strategies: immediate repair strategies such as modifying the treatment task, or expressive repair strategies such as metacommunicating about the rupture and exploring the interpersonal schemas that underlie it. Training in rupture repair has demonstrated benefits for CBT therapists, particularly trainees.     

决策任务类型与结果框架对风险决策的影响

本研究考察生命和金钱问题下,获得和损失框架中决策任务类型对风险决策的影响。采用2（任务领域：生命、金钱）×2（决策任务类型：经验、描述）×2（结果框架：获得、损失）被试间设计,使用卡方检验及logistic回归分析后发现：生命和金钱问题下,个体在直接给出方案可能结果的描述性决策中仅表现出损失框架下的风险偏好;在通过自主查看方案可能结果的经验性决策中未发现结果框架作用。描述−经验差距一致性存在于生命和金钱问题中。     

Stigma and hostility towards pregnant smokers: Does individuating information reduce the effect?

Australia is at the forefront of tobacco control, yet 17% of Australian women smoke during pregnancy. Negative attitudes to smoking are intensified when the smoker is pregnant, consistent with a discourse that encourages surveillance of pregnant women. Such overt anti-smoking attitudes create a context which may make it difficult for pregnant smokers to seek assistance to stop. However, there is little evidence on the extent to which pregnant smokers are stigmatised by community members. We used vignettes to examine the degree of smoking-related stigma expressed by 595 Australian university students who rated a woman, described as a mother who was smoking or not, and pregnant or not. Further, we examined whether provision of individuating information reduced the degree of stigma. Mothers described as smokers were rated more negatively than those not, particularly if they were pregnant: smokers were perceived as unhealthy, and also as bad mothers. Provision of individuating information slightly reduced these effects. These findings support the view that smokers – particularly if pregnant – are subject to negative moral judgement. Our findings contribute to the ethical debate about stigma-inducing tobacco control efforts, and suggest that anti-smoking campaigns that contextualise smoking in pregnancy might reduce stigma and assist cessation.     

Executive functioning in individuals with a history of ASDs who have achieved optimal outcomes

Executive functioning (EF) is examined among children and adolescents once diagnosed with an autism spectrum disorder (ASD), but who no longer meet diagnostic criteria. These individuals have average social and language skills, receive minimal school support and are considered to have achieved “optimal outcomes” (OOs). Since residual impairments in these individuals might be expected in deficits central to autism, and in developmentally advanced skills, EF was examined in 34 individuals who achieved OOs, 43 individuals with high-functioning autism (HFA), and 34 typically developing (TD) peers. Groups were matched on age (M = 13.49), gender, and nonverbal IQ (NVIQ) but differed on verbal IQ (VIQ; HFA < TD, OO). On direct assessment, all three groups demonstrated average EF; however, the OO and HFA groups exhibited more impulsivity and less efficient planning and problem-solving than the TD group, and more HFA participants exhibited below average inhibition than did OO and TD participants. Parent-report measures revealed average EF among the OO and TD groups; however, the OO group exhibited more difficulty than the TD group on set-shifting and working memory. HFA participants demonstrated more difficulty on all parent-reported EF domains, with a clinical impairment in attention-shifting. Results suggest that EF in OO appears to be within the average range, even for functions that were impaired among individuals with HFA. Despite their average performance, however, the OO and TD groups differed on measures of impulsivity, set-shifting, problem-solving, working memory, and planning, suggesting that the OO group does not have the above-average EF scores of the TD group despite their high-average IQs.