Manualizing psychotherapy: Aaron T. Beck and the origins of Cognitive Therapy of Depression

Abstract

This paper examines the origins of psychiatrist Aaron T. Beck’s 1979 Cognitive Therapy of Depression (CTOD). CTOD was the first psychotherapy manual designed to be used in a randomized controlled trial (RCT). Making psychotherapy amenable to the RCT design had been a ‘holy grail’ for leading American psychotherapy researchers since the late 1960s. Beck’s CTOD – which standardized his treatment so it could be compared with drug treatments in a clinical trial – delivered that holy grail, and ushered in the manualized treatment revolution. Manuals are now a sine qua non in psychotherapy research. In this paper, I explore some of the personal, political, and economic variables that made the idea of a manual irresistible to Beck and to those who first championed him.     

Effects of Share the Keys (STK), a comprehensive,behavioral-based training program for parents and new teen drivers in New Jersey

The New Jersey Graduated Driver License (GDL) restrictions were updated in 2010 with changes that included a more active role of parents monitoring practice driving with their teens. In addition to extending the driving phases, there were new curfew and passenger limit restrictions. Teen drivers were also required to use red decals on license plates to identify themselves as inexperienced drivers. The Division of Highway Traffic Safety had partnered with the Motor Vehicle Commission in the past to produce practice driving guides for parents of teen drivers, but recognized the need to support this type of informational campaign with an educational program for helping parents to understand changes in the GDL and recognize the importance of their role in the GDL monitoring process. In 2010, the New Jersey Parent/Teen Driver Orientation program was developed to educate parents of teen drivers on the new GDL restrictions and Children’s Hospital of Philadelphia (CHOP) findings concerning the importance of parenting roles in teen driver safety. Additional resources were incorporated into the orientation that included the Centers for Disease Control (CDC) community based information and the University of Michigan Transportation Research Institute (UMTRI) parent-teen driver contracts.This community-based training, known as the New Jersey Parent/Teen Driver Orientation was later renamed Share the Keys, and had been developed for the state as a component of the New Jersey Highway Safety grant received by Kean University. The comprehensive program was designed to engage parents, teens, educators, and law enforcement in the teen driving process and help parents to understand how personal parenting styles and engagement may impact teen crash risk and compliance with the GDL restrictions. Local representatives from traffic safety and law enforcement teamed with school officials and driver education teachers to present programs in their communities. The evaluation process was built into the program as a pre-survey administered at the beginning of the session, a post-survey completed directly afterward, and a voluntary follow-up survey completed on line or mailed, beginning six months later.Evidence from the first year showed that parents maintained a significant level of engagement throughout the GDL process with their teen drivers. However, findings did establish the need to further examine why Authoritative parenting styles had declined, especially since this parenting approach was considered in the literature as most effective in reducing teen crash risks. Therefore, the scope of this study was broadened to a three year effort that reached over 2800 parents and investigated behavioral outcomes impacted by Share the Keys. While comparisons made between driving phases and parenting styles had yielded no significant results, changes within parenting style scores were shown to be effective over time. The reported levels of Permissive and Uninvolved parents remained consistent throughout all three driving phases, while Authoritarian parenting peaked during the Probationary phase, and Authoritative parenting was noted as highest once teens earned their license.     

IN PRAISE OF A LOGIC OF DEFINITIONS THAT TOLERATES Ω‐INCONSISTENCY

I argue that a general logic of definitions must tolerate ω‐inconsistency. I present a semantical scheme, , under which some definitions imply ω‐inconsistent sets of sentences. I draw attention to attractive features of this scheme, and I argue that yields the minimal general logic of definitions. I conclude that any acceptable general logic should permit definitions that generate ω‐inconsistency. This conclusion gains support from the application of to the theory of truth.     

政策执行偏差严重程度对公众地方政府责任判断的影响机制

为探讨地方政府政策执行偏差严重程度对公众地方政府责任判断的影响机制。采用问卷法对728名社会公众进行调查,结果显示：（1）公众地方政府有意性判断和公众地方政府可控归因中介了政策执行偏差严重程度与公众地方政府责任判断之间的关系。（2）政策执行偏差严重程度还通过公众地方政府有意性判断→公众地方政府可控归因的中介链作用于公众地方政府道德责任判断。并对研究的实践启示进行了讨论。     

Does Exposure to Stereotype‐Disconfirming Politicians Reduce the Effect of Stereotypes on Voting? Evidence From Seven Plagiarism Scandals in Germany

We examine whether exposure to several salient counterexamples reduces the effect of stereotypes on voting. By taking advantage of a series of seven plagiarism scandals in Germany—a country with high regard for academic credentials where academic titles (Dr. and Prof.) get printed on ballot papers—we test whether the tendency to vote for candidates with a doctor's title decreased in the wake of the scandals. Using cross‐sectional and longitudinal estimators and controlling for a large range of potential confounders, we find that the electoral advantage of candidates with a doctor's title shrinks from a good half of a percentage point before the scandals down to a third after the scandals. In line with a subtyping hypothesis, the reduction is stronger for candidates from traditional middle‐class parties (i.e., the parties of the politicians who were implicated in the scandals). Neither of these effects turns out to be strong enough to reach statistical significance, however. We conclude that seven negative examples in one legislative term had no noticeable effect on the tendency to select candidates based on academic titles. Our study provides a rare opportunity to test the effect of stereotype‐disconfirming information on electoral behavior. Our results contribute to a literature demonstrating the resilience of stereotypes to disconfirming information. They also suggest that plagiarism affairs are unlikely to reduce electoral incentives for politicians to obtain a fake doctorate.     

UNDERSTANDING PARENTING STRESS AND CHILDREN'S BEHAVIOR PROBLEMS AMONG HOMELESS,SUBSTANCE‐ABUSING MOTHERS

This article tested a model of parenting stress as a mediator between maternal depressive symptoms, emotion regulation, and child behavior problems using a sample of homeless, substance‐abusing mothers. Participants were 119 homeless mothers (ages 18–24 years) and their young children (ages 0–6 years). Mothers responded to questions about their depressive symptoms, emotion regulation, parenting stress, and child behavior problems. A path analysis showed that maternal depressive symptoms were positively associated with child behavior problems through increased parenting stress whereas maternal cognitive reappraisal was negatively associated with child behavior problems through decreased parenting stress. Moreover, maternal expressive suppression was negatively related to child externalizing problems. Findings support the parenting stress theory and highlight maternal parenting stress as a mechanism associated with homeless children's mental health risk. This study has significant implications for understanding the parenting processes underlying child's resilience in the context of homelessness and maternal substance use.     

Action‐semantic and syntactic deficits in subjects at risk for Huntington's disease

Frontostriatal networks play critical roles in grounding action semantics and syntactic skills. Indeed, their atrophy distinctively disrupts both domains, as observed in patients with Huntington's disease (HD) and Parkinson's disease, even during early disease stages. However, frontostriatal degeneration in these conditions may begin up to 15 years before the onset of clinical symptoms, opening avenues for pre‐clinical detection via sensitive tasks. Such a mission is particularly critical in HD, given that patients’ children have 50% chances of inheriting the disease. Against this background, we assessed whether deficits in the above‐mentioned domains emerge in subjects at risk to develop HD. We administered tasks tapping action semantics, object semantics, and two forms of syntactic processing to 18 patients with HD, 19 asymptomatic first‐degree relatives, and sociodemographically matched controls for each group. The patients evinced significant deficits in all tasks, but only those in the two target domains were independent of overall cognitive state. More crucially, relative to controls, the asymptomatic relatives were selectively impaired in action semantics and in the more complex syntactic task, with both patterns emerging irrespective of the subjects’ overall cognitive state. Our findings highlight the relevance of these dysfunctions as potential prodromal biomarkers of HD. Moreover, they offer theoretical insights into the differential contributions of frontostriatal hubs to both domains while paving the way for innovations in diagnostic procedures.     

Increasing the salience of fluency cues does not reduce the recognition memory impairment in Alzheimer's disease!

In Alzheimer's disease (AD), it is now well established that recollection is impaired from the beginning of the disease, whereas findings are less clear concerning familiarity. One of the most important mechanisms underlying familiarity is the sense of familiarity driven by processing fluency. In this study, we attempted to attenuate recognition memory deficits in AD by maximizing the salience of fluency cues in two conditions of a recognition memory task. In one condition, targets and foils have been created from the same pool of letters (Overlap condition). In a second condition, targets and foils have been derived from two separate pools of letters (No‐Overlap condition), promoting the use of letter‐driven visual and phonetic fluency. Targets and foils were low‐frequency words. The memory tasks were performed by 15 patients with AD and 16 healthy controls. Both groups improved their memory performance in the No‐Overlap condition compared to the Overlap condition. Patients with AD were able to use fluency cues during recognition memory as older adults did, but this did not allow to compensate for dysfunction of recognition memory processes.