Reasons for clinical research: Characteristics of contributors and their contributions to the Journal of Consulting and Clinical Psychology.

A representative sample of contributors (333) to the Journal of Consulting and Clinical Psychology was asked to report on their motivations for conducting studies that had been published in that journal. Results indicate that the primary motivation of these clinical researchers was to build on prior theory and research through the gathering and analysis of new data to answer socially significant applied-clinical questions. More immediate pragmatic considerations (e.g., tenure, funding, degree or job requirements, and availability of Ss) were reported to be of secondary, but nevertheless significant, importance. Most respondents described the training model in which they had received their doctoral education or oriented toward an integrated scientist-practitioner approach rather than one that focused primarily on research, therapy, or assessment training. It was also found that these clinical researchers rarely conducted investigations in the context of community service or consultation interventions or in order to replicate past research. Results are discussed in light of current controversies in clinical psychology concerning the optimal model for training and the relevance of clinical research. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evidence missing from evidence-based practice.

Comments on the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. Regrettably, the task force report was largely silent on three critical issues. As a consequence, it omitted much of the evidence necessary for a complete picture of evidence-based practice. First, the task force report did not operationalize "evidence." Second, the task force report did not address the crucial problem of iatrogenic treatments. Third, the task force report said little about the necessity for ongoing objective evaluation of clinical cases, which is critical to ethically responsible services. Current debate centers on how research findings should be factored into interventions, not on whether it is necessary to do so. Rather than waiting for the resolution of competing views on the matter, psychologists bear an ethical obligation to offer evidence-informed services. Three critical steps that were largely neglected by the task force report can go far toward helping psychologists honor that commitment: (a) providing a clearer operationalization of scientific evidence, (b) using current research to rule out the use of potentially harmful methods, and (c) using objective criteria to evaluate all of their cases on an ongoing basis. These steps, in turn, clarify the menu of options available to therapists, help protect clients from harm, and offer the advantage of allowing clinicians to contribute to the growing body of knowledge about what does and does not work in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Editorial policy for Neuropsychology.

With the publication of Neuropsychology by the Philadelphia Clinical Neuropsychology Group (PCNG) in 1987, it is hoped that PCNG will meet the growing need of practitioners and consumers for both practical and theoretical information regarding service delivery in clinical neuropsychology. In keeping with the PCNG tradition, the aim of Neuropsychology is education: to provide the readership with materials to improve the quality of service delivery to patients with diseases or disorders related to the central nervous system. Basic clinical research on memory, learning, perception, language, sensory-motor functioning and so on are welcome publications in Neuropsychology, as their findings fit well with clinical practice commitments. Case reports, scholarly review articles, reviews of books, software programs, and test materials, and announcements of upcoming events are also welcomed. The intent is to make Neuropsychology a scholarly refereed journal of PCNG and to include articles written not only by PCNG members but other interested individuals as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient psychotherapy with dangerous clients: A model for clinical decision making.

The precedent-setting 1976 judicial decision of Tarasoff v. Regents of the University of California established a duty to protect whereby psychotherapists are expected to exercise reasonable care to protect the potential victims of their clients' violent behavior. However, no standard of care for dangerous clients has been established. In this article, the authors present a model for clinical decision making to determine the best interventions for dealing with dangerous outpatient clients. The model takes into account the degree of violence risk and the strength of the therapeutic alliance. Four cases are presented to illustrate the application of the model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Defining the physician's duty to warn: consensus statement of Ontario's Medical Expert Panel on Duty to Inform

Ontario's Medical Expert Panel on Duty to Inform was formed to consider the duty of Ontario physicians in circumstances where a patient threatens to kill or cause serious bodily harm to a third party. The panel was concerned about the implications of any duty to inform on the integrity of the physician-patient relationship, particularly with respect to confidentiality. The panel agreed that regulations safeguarding the confidentiality of patient information ought to be changed only if there is a critical reason for doing so, but, after deliberation, the panel members concluded that the need to protect the public from serious risk of harm is a paramount concern that should supersede the duty of confidentiality. The recommendations reported here were endorsed in principle by the panelists and the groups they represented (the Royal College of Physicians and Surgeons of Canada, the Canadian Medical Protective Association, the College of Physicians and Surgeons of Ontario, the Ontario College of Family Physicians and the Ontario Medical Association) and are being implemented by the College of Physicians and Surgeons of Ontario.     

Ethical issues in field research: Balancing competing values.

Discusses the conflict between experimental and ethical values inherent in psychological field research. The problem has special significance in community psychology, which gives priority to studying, in natural settings, those affected by social problems. An example is given of research that required observation of family interaction in the homes of convicted child abusers. The case demonstrates that the value of ecological validity often conflicts with the need to protect privacy and obtain uncoerced consent. Other ethical constraints, including the duty to report lawbreaking and to protect the public from harm, may threaten research validity. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Defining specific goals of therapy in treating dyslipidemia in the patient with low high-density lipoprotein cholesterol

Because patients with low high-density lipoprotein (HDL) cholesterol (HDL-C) are at high risk for clinical coronary artery disease (CAD) events, these patients require aggressive treatment with lifestyle modifications-increased exercise, smoking cessation, and weight loss in overweight patients-and available pharmacological agents. Drugs that raise HDL-C include nicotinic acid, fibric acid derivatives, estrogens, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), alpha-blockers, and alcohol. However, all agents that increase HDL-C may not have the same clinical benefit, just as, as shown in genetic studies in humans and mice, genetic causes of high HDL-C do not always protect against CAD, nor do genetic causes of low HDL-C always increase risk for CAD. Better understanding of the complexities of HDL metabolism and the mechanisms by which HDL protects against CAD is needed to enable the development of new therapeutic strategies--novel drugs or gene delivery systems--to increase HDL-C and reduce CAD events. The statins are the agents with the greatest evidence for slowing progression of CAD and reducing clinical events in patients with low HDL-C, but additional research is needed to determine the potential benefits of additional interventions that increase HDL-C, including combination therapy, which may provide greater improvements in the entire lipid profile.     

Joining science and application: Ethical challenges for researchers and practitioners.

The Ethical Principles of Psychologists and Code of Conduct (American Psychological Association [APA], 1992) stresses the importance of a scientific base for professional practice and implementation of research procedures that protect participant welfare. This article examines 3 ethical concerns flowing from the science-practice relationship: (1) Does current research provide a scientific base for psychological interventions? (2) Do psychologists have an empirical foundation for addressing the needs of diverse populations? (3) Is the welfare of psychologically vulnerable research participants protected? A survey of 323 articles published in APA journals during 1991 indicates the need to increase the scientific evaluation of psychological treatments, the documentation of client and practitioner characteristics as they relate to service delivery, and the enlistment of practitioners in referral procedures for research participants in need of psychological treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minimal therapist-assisted cognitive–behavioral therapy interventions in stepped care for childhood anxiety.

New effective, efficient, and accessible service delivery methods for cognitive–behavioral therapies for pediatric anxiety disorders are needed. Many anxious children do not receive needed treatment because of barriers such as limited availability of trained practitioners, costs of treatment, and time. A cognitive–behavioral therapy (CBT) stepped care approach that “steps up” care as needed from less intensive therapies with minimal therapist assistance to therapist-directed treatment may address barriers and provide more accessibility to treatment. A stepped care approach does not necessarily mean that traditional weekly face-to-face therapy sessions will not be needed. However, different service delivery methods that begin with CBT minimal therapist-assisted interventions may be a first line of treatment because not all children may need the full treatment package. This article provides an overview of the current research on CBT minimal therapist-assisted interventions (i.e., modified CBT protocols, computer-based therapy, bibliotherapy, telephone-based therapy, group treatment, and pharmacology) and information on how these first-line treatments may be incorporated into a stepped care model. Minimal therapist-assisted interventions within a stepped care model are in the early stages of development, although there is evidence that these types of treatment may be a viable first step to treating pediatric anxiety disorders. More research on minimal therapist-assisted interventions within stepped care models is needed, and challenges associated with disseminating and implementing stepped care need to be addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction: Methodological issues in school-based mental health services research.

New research directions on the effectiveness of mental health services for children and adolescents offer the opportunity for school psychology to apply its knowledge base to the systemic juncture between mental health and school systems. Models of service delivery to children, adolescents, and their families that integrate school, mental health, and other service sectors are being actively studied to answer questions about the outcomes of these services for children with mental health problems. The papers in this journal were first presented at the 6th Annual Research Conference of the Florida Mental Health Institute on "A System of Care for Children's Mental Health: Expanding the Research Base." The papers describe state-of-the art studies of school-based mental health interventions for children, adolescents, and their families. In each of the papers, particular attention is paid to the salient methodological issues researchers face in conducting these studies within school settings. It is hoped that these articles will foreground the healthy and creative tensions that exist between different research paradigms and multiple service communities, especially mental health and school systems, by encouraging new research on important and as yet unanswered questions about the effectiveness of school-based service delivery to children and adolescents with mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Future of Health Psychology Interventions.

Progress in health psychology interventions was reviewed to manage chronic illness, treat psychophysiological disorders, and provide complementary treatment for difficult medical symptoms. A closer synergy between research, clinical applications and public policy, and education and training was advocated to guide future work in these areas. Further, the importance of clinical input informing research directions, the need for interventions to focus on a broader range of individual difference and contextual factors, and for effectiveness studies to influence the adoption of treatments in clinical settings was emphasized. In accordance, greater effort should be devoted to disseminating information on treatment effectiveness to professional and lay groups to maximize the public health benefit of established intervention approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tarasoff and the researcher: Does the duty to protect apply in the research setting?

In the decade since the Tarasoff decision, psychotherapists have become increasingly concerned about their responsibility to protect potential victims of their patients' violent behavior. Similarly, researchers in the mental health professions have expressed growing concern over their possible parallel obligations with regard to their research subjects. No case law to date imposes such a duty on researchers, but our analysis suggests that the congruence between the training and function of clinical researchers and psychotherapists will provide the touchstone for application of the duty to protect. In this article we discuss the issues that researchers should consider in assessing their potential duties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of appearance-based interventions on sun protection behaviors.

Objectives: To examine the longer term efficacies of exposure to UV photographs and photoaging information (e.g., wrinkles and age spots) for increasing sun protection intentions and behaviors of young adults. Design: Randomized controlled trial with 4- to 5-month and 12-month follow-ups. Main Outcome Measures: Participants' self-reported sun protection intentions assessed immediately after the interventions, and both self-reported sun protection behaviors and an objective assessment (via spectrophotometry) of skin color change measured at the end of summer (4-5 months following interventions) and 1 year following interventions. Results: Both interventions resulted in immediate positive effects on future sun protection intentions. Both interventions showed objective evidence of less skin darkening at the postsummer follow-up, with those in the photoaging information condition also reporting more sun protective behavior and continuing to show less skin darkening 1 year after intervention. There was also evidence that effects of photoaging information on subsequent skin color change were mediated by the earlier positive effect photoaging information had on participants' intentions to sun protect and their subsequent sun protection behaviors. Conclusions: UV photo and photoaging-information interventions each show promise as a brief and relatively inexpensive approach for motivating sun protection practices that may reduce skin cancer risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-cultural differences in children's choices, categorizations, and evaluations of truths and lies.

This study examined cross-cultural differences and similarities in children's moral understanding of individual- or collective-oriented lies and truths. Seven-, 9-, and 11-year-old Canadian and Chinese children were read stories about story characters facing moral dilemmas about whether to lie or tell the truth to help a group but harm an individual or vice versa. Participants chose to lie or to tell the truth as if they were the character (Experiments 1 and 2) and categorized and evaluated the story characters' truthful and untruthful statements (Experiments 3 and 4). Most children in both cultures labeled lies as lies and truths as truths. The major cultural differences lay in choices and moral evaluations. Chinese children chose lying to help a collective but harm an individual, and they rated it less negatively than lying with opposite consequences. Chinese children rated truth telling to help an individual but harm a group less positively than the alternative. Canadian children did the opposite. These findings suggest that cross-cultural differences in emphasis on groups versus individuals affect children's choices and moral judgments about truth and deception. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV risk reduction interventions for persons with severe mental illness

Recent seroprevalence studies have shown alarming rates of HIV infection among severely mentally ill men and women in large urban areas, and HIV behavioral epidemiology research indicates that a substantial proportion of seriously mentally ill adults engage in activities that increase their vulnerability to HIV/AIDS. In this paper, the research literature on HIV prevention interventions is reviewed including reports that have described HIV prevention programs, studies that have used uncontrolled pre- and postintervention methods to evaluate risk reduction interventions, and those that have used rigorous randomized designs and examined risk behavior change. Collectively, these studies show that intensive, small-group interventions that target a variety of risk-related dimensions-including knowledge, attitudes, and motivations, and behavioral and cognitive skills-can produce at least short-term reductions in high-risk sexual behavior among the severely mentally ill. A number of gaps in the research literature are identified including the need to: (a) better tailor interventions to risk situations encountered by the mentally ill; (b) develop gender-tailored interventions; (c) examine and implement HIV prevention programs so they help persons sustain behavior change; (d) explore one-on-one counseling and community-level intervention methods; and (e) develop risk reduction interventions for already-seropositive individuals. Implications for service provision are discussed.     

From clinical trials to professional training: A graduate course in evidence-based interventions for children, youth, and families.

In preparing students to become competent professional psychologists, graduate coursework must lay the foundation for the development of competence in the ethical delivery of evidence-based interventions. This paper describes a graduate course designed to introduce students to evidence-based treatments with children and youth. The course is designed to enhance critical thinking in translating research into practice as well as to develop core competencies in intervention planning, implementation, and evaluation. Activities to enhance interaction and to promote problem-based learning include student presentations of a workshop on an effective practice element, as well as a case assignment requiring treatment planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reporting risks and benefits of therapy by use of the concepts of unqualified success and unmitigated failure: applications to highly cited trials in cardiovascular medicine

BACKGROUND: The NNT (number needed to treat) and NNH (number needed to harm) are useful in conveying the results of clinical trials because they emphasize the effort that must be expended to accomplish a single, tangible outcome. But NNT conveys the effort required to achieve a positive outcome without distinguishing between the presence or absence of treatment-related adverse events. Similarly, NNH conveys harm without accounting for the achievement or lack of achievement of the benefit of therapy. Consequently, a mathematical model was developed to extend the NNT and NNH to represent the effort required to achieve "unqualified success" (NNTUS, treatment success without treatment-induced side effects) and "unmitigated failure" (NNHUF, lack of treatment success with treatment-induced side effects). METHODS AND RESULTS: NNTUS was calculated by adjusting the absolute risk reduction to allow for the probability of not incurring a treatment-related adverse event. NNHUF was similarly calculated by adjusting the absolute risk of incurring a treatment-related adverse event by the probability of not incurring any treatment-related benefit. The impact of conveying clinical trial data by the use of NNT, NNTUS, NNH, and NNHUF is illustrated by means of 11 highly cited trials identified systematically from the cardiovascular literature. The treatment effort measured by the NNTUS and the NNHUF was consistently higher than that given by the traditional NNT and NNH. These increments ranged from 1% to several hundred percent. CONCLUSIONS: The NNTUS and the NNHUF represent the treatment effort required on average to achieve 1 unqualified success and 1 unmitigated failure. NNTUS and NNHUF balance benefit and harm in an objective way and are relevant for making service delivery decisions.     

HIV, confidentiality, and duty to protect: A decision-making model.

Mental health professionals are confronted with complex issues surrounding confidentiality and duty to protect when treating clients with HIV. These professionals need to consider various factors when applying Tarasoff principles to protect potential victims, including the foreseeability of harm, the identifiability of the victim, and appropriate protective action. Professional ethical guidelines and legal mandates also need to be considered. The purpose of this article is to discuss the ethical and legal dilemmas faced by clinicians and to introduce a decision-making model that takes into account individual state laws. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Risk Assessment as an Integral Aspect of Capacity Evaluations.

Objective: To highlight the need for rehabilitation psychologists' evaluation of potential risks when examining an individual's decision-making capacity (DMC). Design: A literature review of research regarding decision making, predictive accuracy, and rehabilitation outcomes. Conclusions: The perceived level of risk or potential harm entailed in a decision determines the "sliding scale" for DMC. There is much less research on risk assessment than on the cognitive components needed for DMC, meaning that clinicians usually have to rely on clinical judgment. Clinical judgment is often inaccurate in terms of identifying factors that could increase the risk for harm and is susceptible to errors when predicting future risk. It is therefore argued that the process of assessing an individual's DMC must be matched by an equally rigorous analysis of clinicians' ability to quantify situational risk. Only when these 2 components are properly considered can an adequate standard for DMC be established. (PsycINFO Database Record (c) 2010 APA, all rights reserved)