Review of studies evaluating psychotherapy in bulimia nervosa: the influence of research methods

The purpose of the study was to test if design and research methods of studies predict outcome results of bulimia nervosa. Fifty-seven articles on outcome of bulimia nervosa were found through MEDLINE and PSYCHINFO databases and 25 were included in the statistical analysis. Percentages of patients with a good outcome ranged from 24% to 74% with a mean of 51.1%. The variables best predicting outcome were time to follow-up and number of symptoms evaluated in definition of good outcome whereas dropout, design of studies, treatments, and sample characteristics did not predict significantly. The implications of these findings are discussed.     

Active-imaginal exposure: examination of a new behavioral treatment for cynophobia (dog phobia)

The aims of this study were to investigate exposure-based treatments for cynophobia (dog phobia) and to test a newly developed hybrid imaginal exposure treatment that we have named active imaginal exposure. The treatment introduces an in vivo coping component to imaginal exposure whereby the patient physically performs coping responses to an imagined feared stimulus. Eighty-two participants meeting DSM-IV criteria for specific phobia (animal subtype) were randomly assigned to one of three 30-min. treatments: (a) active-imaginal exposure (AI), (b) imaginal exposure alone (IE), or (c) graduated in vivo exposure (IV). Participants completed a behavioral approach test at pre, post, and four-week follow-up. Significant pre- to posttreatment improvement was observed in all three treatment conditions. Response rates at posttreatment were 51.9, 62.1, and 73.1% for the IE, AI, and IV groups respectively. Likewise, effect sizes at posttreatment were 0.76, 1.41, and 1.55 for the IE, AI, and IV groups respectively. Although in the predicted direction, the between group differences were not significant. A similar pattern of results was observed at follow-up. Further, safety behavior utilization during treatment was associated with less improvement--particularly in the two imaginal treatment conditions. Exposure treatments of dog phobia appear feasible and effective in reducing phobic fear and avoidance associated with dog phobia. Furthermore, preliminary evidence suggests that our active-imaginal exposure treatment may be a viable alternative to in vivo exposure.     

An outcome management program for extending advances in choice research into choice opportunities for supported workers with severe multiple disabilities

We evaluated an outcome management program for increasing choice opportunities provided by 2 job coaches for 5 supported workers with severe multiple disabilities in a community job. The program involved specifying and monitoring behavioral outcomes among workers and staff, training staff, and supportive and corrective feedback. Increased choice provision occurred for both job coaches across a 1-year period. Results indicate how outcome management can help translate advances in choice research into routine practice.     

Measuring Qualitative Aspects of Preschool Boys' Noncompliance: The Response Style Questionnaire (RSQ)

Child noncompliance is a core maladjustment factor in current clinical models of aggression and antisocial development. However, little is known about the relations among qualitative aspects of child noncompliance and aggressive maladjustment. The authors developed the Response Style Questionnaire, an instrument designed to measure the multidimensional qualities of child noncompliance, and tested its validity and reliability. Tests of internal validity provided a five-factor solution, featuring distinctions in noncompliance quality between and among skilled noncompliance (verbally skilled and emotionally regulated) and unskilled noncompliance (overt/confrontational, covert/sneaky, and emotionally labile). Theory-driven tests of external validity using peer-adjustment variables as criteria provided discriminant prediction (a) among qualitatively distinct aspects of noncompliance and (b) between noncompliance qualities and rate. Discussion focuses on a modified view of the nature and role of noncompliance in aggressive and antisocial development.     

Psychotherapy Process Measure Research and the Evaluation of Psychotherapy Orientation: A Narrative Analysis

This article discusses the need for a systematic method that enables researchers to evaluate integrative therapy approaches using a range of therapy process measures. The Narrative System Process Coding (NPCS; Angus, Hardtke, & Levitt, 1996) is proposed as such a method, and is applied with the Experiencing Scale (Klein, Mathieu, Gendlin, & Keisler, 1970) and the Levels of Client Perceptual Processing (LCPP; Toukmanian, 1986) to three brief good outcome integrative therapy modalities to illustrate this need. The study found higher Experiencing Scale scores to be most strongly related to an experiential approach to therapy and to the NPCS internal narrative processes. Higher LCPP scores were most strongly related to the NPCS reflexive narrative process and to a perceptual-processing approach. The discussion initiates a discourse on the importance of explicating process measures' origins when comparing different therapy approaches in order to allow for the meaningful consolidation of process research findings.     

The Role of Schools in Outcomes for Youth: Implications for Children's Mental Health Services Research

We explore the role of schools in children's mental health services research. Recent literature has suggested that schools play an important role in delivering services to children and adolescents with emotional and behavioral problems. Research in services research, though, has taken a fairly narrow view of which dimensions of school environments are relevant for inclusion in studies. We suggest that a broader view of school environments is appropriate and potentially beneficial to the field. Using Bronfenbrenner's ecological model as a guide, we conceptualize schools as microsystems. Such an approach suggests that all aspects of school environments (treatment as well as non-treatment) are likely to influence many of the outcomes that children's mental health services research frequently targets (e.g., behavioral problems, problematic peer relationships, academic achievement, school attendance). We review literature from a variety of disciplines to suggest relevant features of schools, with particular attention to the role of peer dynamics within schools. We conclude with implications of this expanded conceptualization of schools for children's mental health services research.     

The Strengths and Limitations of Case Record Reviews in Examining Family Preservation Outcome Formulation and Treatment Planning

Much debate has centered on what are reasonable outcomes of the short-term intensive family preservation services (IFPS). However, little attention has been given to how therapists actually formulate outcomes in their practices. The files of 98 families who used IFPS were reviewed to determine how therapists formulated outcomes and whether formulated outcomes varied by service sector (child welfare or mental health) and child age. It was found that formulated outcomes in mental health were more likely than those in child welfare to have a child focus and an interpersonal locus. Variation in outcome formulation in child welfare by child age was found, with outcomes of younger children more likely to be parent-focused than were outcomes of older children. The issues pointed out by these findings are discussed. Since case records are a potential data source for researchers, the paper concludes with a discussion of the strengths and limitations of case record reviews for research purposes.     

The Counseling Center Assessment of Psychological Symptoms Distress Index: A pragmatic exploration of general factors to enhance a multidimensional scale

Objective: The authors attempted to develop and validate a general distress index for a multidimensional psychological symptom/outcome measure used in over 300 college counseling centers with more than 100,000 cases annually: the Counseling Center Assessment of Psychological Symptoms (CCAPS). Method: Four models were compared for fit indices (n = 19,247): the existing first-order factor model (without a general factor), a second-order factor model, a bifactor model, and a single factor or “total score” model. In separate clinical and non-clinical samples, concurrent and divergent validity were examined using several well-established measures of psychological symptoms, as well as two-week test–retest and treatment utilization data. Results: Second-order and bifactor models which captured a single “distress” factor both exhibited good fit to the data relative to the baseline and “total score” model. Validity data indicated that factors adequately measured meaningful clinical onstructs. Conclusion: Both the bifactor and second-order models indicated the presence of a “distress index” comprised items across many of the CCAPS subscales. This distress scale has strong applicability for benchmarking the overall severity and complexity of patients at different centers, and can be used to help identify colleges and universities with areas of clinical strength, which can be studied to improve the field. Clinically, the distress index offers a parsimonious and efficient method for clinicians to monitor patients’ progress through treatment.     

个体对效价预期和风险评估的时程加工机制:来自ERP的证据

采用事件相关电位技术(ERP),通过简单赌博任务,操纵结果预期的效价(输或赢)与风险(高风险与低风险),考察了个体对结果预期阶段的效价和风险评估的脑内时程动态加工过程。脑电结果发现:(1)在N2成分上,结果预期的效价主效应显著,预期输比预期赢能够引起更大的N2波幅;结果预期的风险主效应不显著。(2)在N500成分上,效价与风险之间的交互作用边缘显著,进一步简单效应分析发现,在预期输的条件下,肯定会输的N500波幅显著大于可能会输;而在预期赢的条件下,肯定会赢与可能会赢之间的N500波幅差异不显著。这说明,在不确定决策过程中的结果预期阶段,个体可能先对结果预期的效价进行加工,然后再对风险进行评估。     

Perceiving a story outside of conscious awareness: When we infer narrative attributes from subliminal sequential stimuli

Perceiving a story behind successive movements plays an important role in our lives. From a general perspective, such higher mental activity would seem to depend on conscious processes. Using a subliminal priming paradigm, we demonstrated that such story perception occurs without conscious awareness. In the experiments, participants were subliminally presented with sequential pictures that represented a story in which one geometrical figure was chased by the other figure, and in which one fictitious character defeated the other character in a tug-of-war. Although the participants could not report having seen the pictures, their automatic mental associations (i.e., associations that are activated unintentionally, difficult to control, and not necessarily endorsed at a conscious level) were shifted to line up with the story. The results suggest that story perception operates outside of conscious awareness. Implications for research on the unconscious were also briefly discussed.