Extended problem solving treatment for depression

Introduction: Effective brief psychological approaches for depression that can be delivered by a variety of health professionals with minimal training increase access to treatment by patients. Problem Solving Treatment (PST) was developed for primary care and was modified for this study (EPST) to better meet the needs of mental health patients. Method: A total of 92 therapists from different professional backgrounds completed EPST workshops and treated 92 patients with major depression with interval clinical and treatment process assessments. Results: EPST achieved a significant reduction in depressive symptom scores, life problem scores, and there were few treatment non‐completers. Treatment outcome was predicted by process and therapist variables. Discussion: EPST is an effective and easy to teach treatment that can be delivered by a variety of practitioners and suitable for busy primary mental health care settings.     

Do Cognitive Interview Instructions Contribute to False Beliefs and Memories?

To examine whether exposing people to false events using instructions taken from the cognitive interview creates false beliefs and false memories, we conducted an experiment where participants took part in two sessions. First, they rated how confident they were that they had experienced certain childhood events and their memories of those events; they also rated how plausible they thought the events were. Second, 2 weeks later, participants were exposed to two of three false target events: one high, one moderate, and one low plausibility. For the first event, participants were instructed to either report everything or mentally reinstate the event context. For the second event, participants received both instructions. The third event was the control event about which participants received no instructions. Finally, participants rated their confidence and memories the second time. The results showed that the cognitive interview instructions had little to no effect on the development of false beliefs and false memories. Copyright © 2012 John Wiley & Sons, Ltd.     

Spiritual Development in the Fourth Quarter of Life

SUMMARY

Spirit, the activating or essential principle influencing a person, and body interpenetrate each other but do not dominate each other in predictable ways. Normal aging is neither a failure of the human spirit nor a failure in the body's Biology. The spirit becomes more apparent as a result of spiritual development.

The fourth quarter of life covers age 75 to 100 years. Prior to age 75, the human spirit undergoes significant developmental events: a crisis of meaning which may result in conversion or more commonly stripping or shedding; transitions, including loss of clearly defined roles and loss of the sense that the individual's life makes a difference.

One motif applied by our culture to old age is the “iconic illusion”; however, it is evident that in some respects this motif has limited application to the fourth quarter of life. “Meaning making” is, in fact, enhanced in the fourth quarter of life, given reasonable levels of cognitive health. The desire and ability to make sense out of existence, to draw together an understanding of a meaningful life trajectory, is best done in the fourth quarter of life. The dominant sense of time in the fourth quarter of life particularly facilitates spiritual development.     

The Effects On and Of Depression - An Exploratory Study of Rehabilitation and Secondary Prevention in Coronary Artery Disease

Forty consecutive participants in a comprehensive, behaviourally oriented coronary rehabilitation and secondary prevention program were followed for three years. Changes in depression (as measured with the Beck Depression Inventory) as well as the influence of baseline levels of depression on achieved changes in lifestyle behaviour and on rehabilitation and secondary prevention effects were analyzed. Subjects with moderate levels of baseline depression experienced short-term reductions of depression, which was maintained at the 12-month follow-up. Clinically depressed subjects experienced less positive results, with smaller immediate reductions as well as relapse to baseline levels after 12 months, specifically in non-physical, cognitive-affective depression symptoms. There were, however, no differences in lifestyle changes or in hospital treatment between groups with different pre-treatment depression levels. These results are discussed in relation to earlier research on the detrimental effects of depression on the prognosis of coronary artery disease.     

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.     

Therapist Awareness of Client Resistance in Cognitive-Behavioral Therapy for Generalized Anxiety Disorder

Clients' resistance relates negatively to their retention and outcomes in psychotherapy; thus, it has been increasingly identified as a key process marker in both research and practice. This study compared therapists' postsession ratings of resistance with those of trained observers in the context of 40 therapist–client dyads receiving 15 sessions of cognitive-behavioral therapy for generalized anxiety disorder. Therapist and observer ratings were then examined as correlates of proximal (therapeutic alliance quality and homework compliance) and distal (posttreatment worry severity) outcomes. Although there was reasonable concordance between rater perspectives, observer ratings were highly and consistently related to both proximal and distal outcomes, while therapist ratings were not. These findings underscore the need to enhance therapists' proficiency in identifying important and often covert in-session clinical phenomena such as the cues reflecting resistance and noncollaboration.     

Intolerance of Uncertainty Mediates the Relation Between Generalized Anxiety Disorder Symptoms and Anger

Previous research has shown that individuals with generalized anxiety disorder (GAD) report elevated anger compared with nonanxious individuals; however, the pathways linking GAD and anger are currently unknown. We hypothesized that negative beliefs about uncertainty, negative beliefs about worry and perfectionism dimensions mediate the relationship between GAD symptoms and anger variables. We employed multiple mediation with bootstrapping on cross-sectional data from a student sample (N = 233) to test four models assessing potential mediators of the association of GAD symptoms to inward anger expression, outward anger expression, trait anger and hostility, respectively. The belief that uncertainty has negative personal and behavioural implications uniquely mediated the association of GAD symptoms to inward anger expression (confidence interval [CI] = .0034, .1845, P_M = .5444), and the belief that uncertainty is unfair and spoils everything uniquely mediated the association of GAD symptoms to outward anger expression (CI = .0052, .1936, P_M = .4861) and hostility (CI = .0269, .2427, P_M = .3487). Neither negative beliefs about worry nor perfectionism dimensions uniquely mediated the relation of GAD symptoms to anger constructs. We conclude that intolerance of uncertainty may help to explain the positive connection between GAD symptoms and anger, and these findings give impetus to future longitudinal investigations of the role of anger in GAD.     

The Impact of Childhood Physical Abuse and Age of Sexual Initiation on Women's Maladaptive Posttraumatic Cognitions

Child abuse survivors often exhibit long-standing maladaptive beliefs. Sexual risk-taking could contribute to the maintenance of such beliefs by reinforcing cognitions that originally resulted from child abuse. In this study, 64 community women, most with elevated posttraumatic stress disorder symptoms, completed measures of childhood abuse, sexual risk-taking, and posttraumatic cognitions. Age of first consensual sexual intercourse mediated the relationship between childhood physical abuse and maladaptive posttraumatic cognitions in adulthood. Thus, age of sexual intercourse initiation might play an important role in women's recovery from childhood physical abuse. Clinicians should consider the possible impact of women's sexual history when challenging their cognitions during trauma-based cognitive behavioral therapy. Further, decreasing risky sexual behavior might partially protect against the negative effects of trauma.     

Associations of general religiousness and specific religious beliefs with coping appraisals in response to Hurricanes Katrina and Rita

An emerging scientific literature is investigating the construct of “compassionate love,” love that is “centered on the good of the other,” a construct empirically linked to physical and mental health. We evaluated effects of an 8-week, 16-hour programme for physicians, nurses, chaplains, and other health professionals, using nonsectarian, spiritually based, self-management tools. Participants were randomised to intervention (n = 30) or wait-list (n = 31). Pretest, post-test, 8- and 19-week follow-up data were gathered on six measures of prosocial qualities. Favorable treatment effects (p<0.05) were found for compassionate love (d = 0.49), altruistic actions (d = 0.33), perspective-taking (d = 0.42), and forgiveness (d = 0.61). Treatment adherence fully mediated effects on compassionate love. Furthermore, stress reduction mediated treatment effects on compassionate love, perspective-taking, and forgiveness; each also mediated gains in caregiving self-efficacy. This encouraging evidence suggests that nonlaboratory psychospiritual interventions can boost compassionate love to benefit the recipients and the larger society.     

Religious upbringing and current religiosity in Spanish nursing and medicine students

The influence of religious education in the family upon current spiritual and religious tendencies was assessed in a sample of 599 Spanish nurse and medicine students using a religiosity scale and answers to a series of belief/disbelief statements. Results showed that nursing and medicine students were equally low-religious, with no differences in religiosity total scores between participants coming from religious families; however, medical students coming from nonreligious families showed higher religiousness than the corresponding nursing trainees. This distinction appeared both across religiosity items and in a variety of responses to belief/disbelief of Christian/secular assertions. Regression analysis showed that religious family background was a consistent predictor of religious beliefs at young adulthood, and its influence was higher for medical students. In addition to establish religious upbringing as an important factor modulating enduring religiosity, these findings provide distinctions between nurse and medical trainees, and reproduce, in a Spanish mainly catholic sample, the structure of religiosity factors previously found on North American mainline protestants.