Treatment-resistant depression: A systematic review of systematic reviews

The objective of this research study was to assess pharmacological, somatic and/or psychological treatments in adults with a diagnosis of major depressive disorder who have not responded to at least one course of antidepressant medication. We conducted a systematic review to identify systematic scientific reviews and meta-analyses on treatment-resistant depression (TRD) published until February 2012. Of the sixty studies selected, sixteen met the inclusion criteria and were therefore included in the review. We considered eight main themes, including the definition of TRD, long-term results, and different treatment strategies, including so-called somatic therapies. Based on the review, the definition of TRD should be standardized in order to achieve a shared conceptualization of this disorder. This would allow a better understanding among clinicians and researchers in the field, promoting a homogeneous research methodology and thus leading to more reliable and comparable results. This essential conceptual clarification would also have a positive impact on patients with TRD, their families, and social and health systems.     

Can Culture Influence Body‐Specific Associations Between Space and Valence?

People implicitly associate positive ideas with their dominant side of space and negative ideas with their non‐dominant side. Right‐handers tend to associate “good” with “right” and “bad” with “left,” but left‐handers associate “bad” with “right” and “good” with “left.” Whereas right‐handers' implicit associations align with idioms in language and culture that link “good” with “right,” left‐handers' implicit associations go against them. Can cultural conventions modulate the body‐specific association between valence and left‐right space? Here, we compared people from Spanish and Moroccan cultures, which differ in the strength of taboos against the use of the left hand, and therefore in their preference for the right. Results showed stronger explicit associations between space and valence in Moroccan participants than in Spaniards, but they did not show any increased tendency for right‐handed Moroccans to associate “good” with “right” implicitly. Despite differences in cultural conventions between Spaniards and Moroccans, we find no evidence for a cross‐cultural difference in the implicit association between space and valence, which appears to depend on patterns of bodily experience.     

Conscious and unconscious processing of facial expressions: Evidence from two split‐brain patients

We investigated how the brain's hemispheres process explicit and implicit facial expressions in two ‘split‐brain’ patients (one with a complete and one with a partial anterior resection). Photographs of faces expressing positive, negative or neutral emotions were shown either centrally or bilaterally. The task consisted in judging the friendliness of each person in the photographs. Half of the photograph stimuli were ‘hybrid faces’, that is an amalgamation of filtered images which contained emotional information only in the low range of spatial frequency, blended to a neutral expression of the same individual in the rest of the spatial frequencies. The other half of the images contained unfiltered faces. With the hybrid faces the patients and a matched control group were more influenced in their social judgements by the emotional expression of the face shown in the left visual field (LVF). When the expressions were shown explicitly, that is without filtering, the control group and the partially callosotomized patient based their judgement on the face shown in the LVF, whereas the complete split‐brain patient based his ratings mainly on the face presented in the right visual field. We conclude that the processing of implicit emotions does not require the integrity of callosal fibres and can take place within subcortical routes lateralized in the right hemisphere.     

A Systematic Review and Psychometric Evaluation of Adaptive Behavior Scales and Recommendations for Practice

Adaptive behavior scales are vital in assessing children and adolescents who experience a range of disabling conditions in school settings. This article presents the results of an evaluation of the design characteristics, norming, scale characteristics, reliability and validity evidence, and bias identification studies supporting 14 norm-referenced, informant-based interviews and rating scales designed to measure adaptive behaviors. To derive these results, the manuals for each of these scales were reviewed using a standardized coding procedure, and information about each scale was double-coded by reviewers. Findings reveal that several evidence-based adaptive behavior scales are available to school psychologists. Concluding recommendations address selection and use of adaptive behavior scales as part of a comprehensive assessment, using the optimal methods of administration of adaptive behavior scales, and interpreting resultant scores that have demonstrated the highest levels of reliability and the largest body of validity evidence.     

A Primer on Psychotherapy Process Research: A Review of Cognitive Therapy of Depression

Researchers conducting psychotherapy process research aim to understand the process by which efficacious psychotherapies achieve therapeutic benefits. A key challenge in this research is how to maximise what can be learned from naturalistic longitudinal data. We provide a selective overview of research examining the process of change in cognitive therapy of depression. While the efficacy of this treatment is widely recognised, a consensus regarding how the treatment reduces depressive symptoms and provides protection from relapse and recurrence has yet to be reached. We review the current state of the research addressing the process of change in cognitive therapy, highlighting how specific methodological features can be used to better understand the process by which this treatment achieves its effects. We highlight the importance of two key challenges to making causal inferences from a process–outcome relation: (a) establishing the temporal precedence of predictors to outcome variables, and (b) evaluating whether any relations identified could be spurious. We argue that methodologically rigorous studies tend to support key claims of the model underlying cognitive therapy of depression. We conclude by considering future directions. For example, we highlight the importance of efforts to understand patient characteristics that may moderate process–outcome relations and could ultimately prove useful in tailoring treatment to best suit individual patients.     

Older adults’ perceptions of ageing and their health and functioning: a systematic review of observational studies

Many older people perceive ageing negatively, describing it in terms of poor or declining health and functioning. These perceptions may be related to older adults’ health. The aim of this review was to synthesise existing research on the relationship between older adults’ perceptions of ageing and their health and functioning. A systematic search was conducted of five electronic databases (ASSIA, CINAHL, IBSS, MEDLINE and PsycINFO). Citations within identified reports were also searched. Observational studies were included if they included perceptions of ageing and health-related measures involving participants aged 60 years and older. Study selection, data extraction and quality appraisal were conducted using predefined criteria. Twenty-eight reports met the criteria for inclusion. Older adults’ perceptions of ageing were assessed with a variety of measures. Perceptions were related to health and functioning across seven health domains: memory and cognitive performance, physical and physiological performance, medical conditions and outcomes, disability, care-seeking, self-rated health, quality of life and death. How ageing is perceived by older adults is related to their health and functioning in multiple domains. However, higher quality and longitudinal studies are needed to further investigate this relationship.     

An Ethical Exploration of Barriers to Research on Controlled Drugs

We examine the ethical, social, and regulatory barriers that may hinder research on therapeutic potential of certain controversial controlled substances like marijuana, heroin, or ketamine. Hazards for individuals and society and potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of these substances. Overly strict regulations, fear of legal consequences, stigma associated with abuse and populations using illicit drugs, and lack of funding may, however, limit research on their considerable therapeutic potential. We review the surprisingly sparse literature and address the particular ethical concerns pertinent to research with illicit and addictive substances, such as undue inducement, informed consent, therapeutic misconception, and risk to participants, researchers, and institutions. We consider the perspectives of key research stakeholders and explore whether they may be infected with bias. We conclude by proposing an empirical research agenda to provide an evidentiary basis for ethical reasoning.     

Understanding supervisee nondisclosures in supervision with videorecording review and interpersonal process recall

The purpose of this qualitative multiple case study was to obtain an in‐depth understanding of supervisees' in‐the‐moment nondisclosure experiences, perceptions and internal processes as they occurred in clinical supervision involving videorecording review. The supervisees who participated in the study were students in their first year of a master's‐level counselling practicum in Western Canada. Utilising interpersonal process recall (IPR) interview methods, supervisees were asked to share their moment‐by‐moment nondisclosures that occurred during a recent videorecorded supervision session in which the supervisory dyad reviewed a videorecording of the supervisee's clinical work. Thematic analysis across cases yielded five overarching themes: (a) validation; (b) safety; (c) growth and accomplishment; (d) performance anxiety; and (e) avoidance. The findings revealed a broad range of positive and negative supervisee nondisclosures that were influenced by the supervision modality of videorecording review and the IPR interview. Implications for clinical supervision, limitations of the study and suggestions for future research are discussed.     

Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta‐analysis

Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent–infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta‐analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta‐analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta‐analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta‐analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: –0.46; 95% confidence interval [CI] [–0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent–infant interaction (SMD: –0.10; 95% CI [–0.46, 0.26]), parental depression (SMD: –1.55; 95% CI [–3.74, 0.64]) or parental global distress (SMD: –0.19, 95% CI [–3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation‐based treatment with non‐mentalization‐based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.