Counselor performance in treating anxiety and depressive symptoms in integrated care: A client outcomes study

Depression and anxiety are two of the most common mental disorders treated in Integrated Primary and Behavioral Healthcare programs. We investigated the within and between performance differences of mental health counselors on anxiety and depressive symptomatology in an integrated service with a sample of 1573 clients and 10 licensed professional counselors. The results of growth curves within the framework of Multilevel Modeling showed significant within and between performance differences among counselors treating anxiety and depressive symptoms. Some counselors performed better in treating anxiety symptoms while others did better treating depression. Implications for counselor education, client care, and legislation are provided.     

A Brief History of Metacognitive Therapy: From Cognitive Science to Clinical Practice

Metacognitive therapy (MCT) is proving to be an effective treatment for anxiety and depression with effects that may exceed CBT. It has been described as a paradigm shift in psychotherapy in its theory-driven cognitive science approach and systematic development and evaluation. MCT was developed by Adrian Wells based on an information processing theory, the Self-Regulatory Executive Function model by Wells and Matthews. MCT theory formulates psychological disorders as sharing common causal factors under the influence of metacognition, representing a particular top-down model of biases in cognitive regulation. A key clinical implication was that a core set of interventions could be developed to impact a wide range of symptoms and disorders. In this paper, we trace the historical development of MCT and the major studies that informed theory and practice with the aim of introducing clinicians and researchers to this area and to understand why the metacognitive approach has developed into a treatment that is proving to be potentially more effective than current gold-standard treatments. In doing so, we will draw out the distinctive features of the approach and explore how this might offer a blueprint for scientific advancement in clinical psychology and psychotherapy.     

Primary Care Treatment Integrating Motivation and Exposure for PTSD Symptoms and Hazardous Alcohol Use: A Case Series

Symptoms of posttraumatic stress disorder (PTSD) and hazardous alcohol use are highly comorbid. Research on integrated interventions to address PTSD symptoms and hazardous alcohol use concurrently has demonstrated efficacy, yet integrated treatments are underutilized. Both patient (e.g., stigma, scheduling/logistics) and clinician (e.g., concern about symptom exacerbation and/or treatment dropout) barriers may impede utilization of integrated interventions among those with comorbid PTSD symptoms and hazardous alcohol use. Primary care behavioral health models (PCBH), in which embedded behavioral health providers deliver treatment to individuals with mild or moderate behavioral health symptoms in primary care, may help address treatment barriers by offering accessible behavioral health interventions in a destigmatizing setting. This paper presents two case examples from a randomized controlled trial testing the efficacy of an integrated intervention for PTSD symptoms and hazardous alcohol use developed for and delivered in primary care. Outcome data and session-by-session content for two participants are included, along with discussion of barriers encountered during the course of treatment. Clinician-suggested strategies for navigating barriers to facilitate utilization of integrated interventions for PTSD symptoms and hazardous alcohol use are also discussed.     

Self-compassion reduces parental burnout: Mediation roles of parental psychological control and support

This study investigated the mediating role of parental psychological control (PPC) and support in the relationship between self-compassion and parental burnout syndrome. The study participants included 1185 Vietnamese parents who completed questionnaires regarding demographic information, parental burnout, self-compassion, parental support of the child, and PPC. We used data analyses, including structural equation modeling, to test the mediation roles of PPC and parental support of the child. Our main findings include: (1) self-compassion had a significant negative effect on parental burnout; (2) the mediation roles of PPC and parental support of the child were also significant. These results suggest that parents with high self-compassion tend to provide more support for children in daily parenting, which helps reduce parental burnout. In contrast, parents with low self-compassion were more likely to use PPC, which exacerbated their burnout. The results from this study provide suggestions for creating effective interventions in the family context to reduce parental burnout and improve parenting effectiveness.     

Unweighting infants reveals hidden motor skills

We investigated the role of rate limiting factors in development using walking as a model system. The achievement of bipedal posture and locomotion are among the most significant achievements in an infant's first year, with poor balance and weak muscles long proposed as the rate limiting factors. Compensating for either may reveal upright motor skill that has not yet emerged in the infant's natural repertoire. To probe this question, we unweighted prewalking infants and measured their performance in various standing and walking behaviors while unweighted compared to baseline. Our secondary objective was to determine if the influence of unweighting was related to infants’ locomotor experience. Infants stood unsupported for longer durations with 20% or 40% unweighting. Infants took more independent steps and more steps with one hand held with 40% unweighting. No differences in transition to/from standing were observed. Locomotor experience was related to the influence of unweighting during cruising and walking with a push toy. This is the first report of more advanced motor skills—longer periods of unsupported standing and the emergence of independent walking—revealed by unweighting infants. We interpret our observations to suggest that the refinement of motor control needed to support bipedal posture and locomotion precedes the functional emergence of these skills in infants. In other words, the musculoskeletal components required for walking are slower to develop than the neurological factors – and consequently may be the rate limiters. We further suggest that training regimens including unweighting should be explored in infants with motor delays.     

Protective effect of aerobic fitness on the detrimental influence of exhaustive exercise on information processing capacity

Although aerobic fitness has been thought to protect against the detrimental cognitive effects following exhaustive exercise, available evidence from studies using traditional mean behavioral measures remain somewhat equivocal.PurposeThis study aimed to reconcile this discrepancy by using a novel theory-driven diagnostic tool, the Systems Factorial Technology (SFT).MethodsSixty-six healthy young adults aged from 18 to 30 years old with different levels of aerobic fitness (n = 33 for the higher-fit and lower-fit groups) completed a go/nogo version of redundant-target task before and after a graded exercise test (GXT) until exhaustion. SFT was used to calculate the resilience capacity, which reflects the information processing capacity underlying inhibitory control.ResultsFollowing the GXT, both higher-fit and lower-fit groups showed faster responses while leaving accuracy unchanged as compared to the performance at the pretest. On the other hand, the resilience capacity decreased for the lower-fit group but was maintained for the higher-fit group.ConclusionThe present findings suggest that aerobic fitness may modulate the individual difference in decisional mechanism following exhaustive exercise. In sum, this study offers an alternative mechanistic explanation regarding cognitive individual differences in response to exhaustive exercise and provides novel insights into the significance of maintaining a state of high physical fitness for those who need to perform cognitively challenging tasks under physically stressful conditions (e.g., elite athletes).     

Do maternal power assertive discipline and warmth interact to influence toddlers' emotional reactivity and noncompliance?

Emotional and behavioural self-regulation emerges during infancy and toddlerhood and is heavily influenced by parenting. Parents facilitate toddlers' behavioural regulation (e.g., compliance) by using appropriate control with warmth and managing children's emotional reactivity during situational demands. In contrast, power assertive discipline may strain children's regulatory skills, for example by evoking toddlers' negative affect. However, we have more to learn about how discipline relates to toddlers' self-regulation in the moment and whether concurrent displays of parental warmth may moderate these relations. Mother–toddler dyads (N = 74, M_age = 13.30 months) from low-to-middle income Turkish families participated in a 3-min laboratory task, in which toddlers needed to delay playing with an attractive toy. Maternal discipline, warmth, toddler's emotional reactivity, and noncompliance were coded from observations. Results showed that higher power assertive discipline was associated with more frequent emotional reactivity in toddlers whose mothers' showed warmth during the <84% of the task duration. Maternal warmth was negatively associated with child noncompliance, but warmth did not interact with power assertive discipline in relation to noncompliance. Results suggest that observed power assertive discipline is meaningfully related to toddlers' emotional reactivity and higher levels of expressed maternal warmth attenuates these relations.     

Testing the dopamine overdose hypothesis in action control: A study in people with Parkinson's disease

Prior work on patients with Parkinson's disease (PD) has shown that the administration of dopaminergic medication in the early to intermediate stages of PD benefits (motor) functions associated with the dopamine-depleted dorsal striatal circuitry but may ‘overdose’ and interfere with (cognitive) functions associated with the relatively intact ventral striatal circuitry. The present study aimed to elucidate this so-called dopamine overdose hypothesis for the action control domain. Using a within-subject design in a sample of 13 people with PD, we evaluated the effect of dopaminergic medication on two cognitive processes underlying goal-directed behaviour, namely action selection and initiation through event binding and conflict adaptation. We also investigated whether individual differences in the magnitude of medication effects were associated across these processes. Results showed no indications that dopaminergic medication affects action selection and initiation or conflict adaptation in PD patients. Additionally, we observed no correlations between both cognitive processes nor between individual differences in medication effects. Our findings do not support the notion that dopaminergic medication modulates action control processes, suggesting that the dopamine overdose hypothesis may only apply to a specific set of cognitive processes and should potentially be refined.     

Predictive validity of the theory of planned behaviour: the role of questionnaire format and social desirability

The present study was designed to assess the predictive validity of a theory of planned behaviour extended to include self‐identity, in the context of health‐related food choice. Following criticism of the use of questionnaires in social cognitive research, the impact of questionnaire format (random vs structured) and social desirability on questionnaire responses was assessed. Findings indicated that intention was the principal determinant of food choice; attitude, subjective norm and self‐identity were independently predictive of intention. There was only weak evidence to suggest effects of social desirability or questionnaire format on component relationships. The present study indicates that the impact of questionnaire format and social desirability on models such as the theory of planned behaviour is minimal, and that such models are robust predictors of food choice. Copyright © 1999 John Wiley & Sons, Ltd.