Can we confirm our theories? Can we measure causal effects?: Reply to Kazantzis et al (2001).

Correlations between psychotherapy homework (HW) and recovery from depression (DEP) could be explained by 4 models: (a) HW causes reductions in DEP; (b) reductions in DEP lead to HW compliance; (c) HW and DEP have circular causal effects on each other; and (d) HW and DEP are simultaneously influenced by a 3rd variable, such as motivation. In the D. D. Burns and D. Spangler (2000) (see record 2000-13544-005) study of HW and changes in DEP during the first 12 weeks of therapy using structural equation modeling (SEM), only the first model was consistent with the data. Still, one cannot conclude that a model is true or definitely confirm a causal effect, even with experimental designs. The authors recommend SEM for naturalistic and experimental designs. Quality of HW should be included in future research, as N. Kazantzis, K. R. Ronan, and F. Deane (2001) (see record 2001-05666-023) suggest. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On False Premises and the Hypnotic Enhancement Effect: Reply to Schnall (2004).

Replies to the comments by E. Schnall (see record 2004-13299-016) on the current author's original article (see record 2003-05896-014), which examined whether adding hypnosis enhances cognitive-behavioral pain treatments. Here, the author addresses Schnall's critique point-by-point, and concludes that--Schnall aside--a a voluminous body of research has clearly established that both hypnosis and cognitive-behavioral treatments are useful for reducing pain, and all evidence from a small but growing literature currently suggests that there is no benefit in adding one procedure to the other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral interventions with older adults: Integrating clinical and gerontological research.

Psychotherapeutic interventions utilizing cognitive-behavioral strategies have been used widely with older adults. To appropriately adapt these techniques, characteristics unique to older adults must be taken into account. These factors include aspects of the social environment, cohort effects, cognitive changes with aging, personality, and emotional development, which have been described in an emerging body of research literature from the field of gerontology. In addition, clinical studies have examined the efficacy of cognitive-behavioral interventions in treating older clients for anxiety, depression, insomnia, and other disorders. This review describes current empirical evidence in gerontology and treatment outcome research that informs the practice of psychotherapy in this population and provides recommendations for conducting therapy with older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Treating chronic depression with disciplined personal involvement: Cognitive behavioral analysis system of psychotherapy (CBASP).

Reviews the book, Treating chronic depression with disciplined personal involvement: Cognitive behavioral analysis system of psychotherapy (CBASP) by James P. McCullough Jr. (see record 2006-11486-000). The premise of this book is that therapeutic neutrality does not apply to the psychotherapy of chronically depressed individuals, and that disciplined personal involvement is an efficacious and perhaps necessary component of their treatment. Cognitive behavioral analysis system of psychotherapy (CBASP) is a learning model, in which the therapist focuses on teaching patients to recognize the consequences of their behavior. McCullough addresses practical and theoretical objections to this therapeutic approach, which include fears of overinvolvement, and inappropriate behavior, and clinical risks of flooding patients with excessively personal information and content. Ultimately, most readers will finish reading this volume with many open questions, some specific to McCullough's approach, others related to the challenging condition of chronic depression itself. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Between-individual variability and interpretation of associations between neurophysiological and behavioral measures in aging populations: Comment on Salthouse (2011).

Salthouse (2011) argued that (a) variance between individuals on cognitive test scores remains constant between 20 and 90 years of age and (b) widely recognized problems of deducing functional relationships from patterns of correlations between measurements become especially severe for neuropsychological indices, especially for gross indices of age-related brain changes (e.g., losses of brain volume or increases in white matter lesions). I argue that between-individual variability on cognitive tests does increase with age and provides useful information on causes of age-related cognitive decline. I suggest that problems of inference from correlations are just as difficult for behavioral as for neurophysiological indices and that inclusion, in analyses, of even gross measures of brain status such as loss of volume and white matter lesions can correct misinterpretations that occur when only behavioral data are examined. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clients' emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies.

The authors compared clients' emotional processing in good and bad outcome cases in cognitive behavioral therapy (CBT) and process-experiential therapy (PET) and investigated whether clients' emotional processing increases over the course of therapy. Twenty minutes from each of 3 sessions from 40 clients were rated on the Experiencing Scale. A 2 × 2 × 3 analysis of variance showed a significant difference between outcome and therapy groups, with clients in the good outcome and PET groups showing significantly higher levels of emotional processing than those in the poor outcome and CBT groups, respectively. Clients' level of emotional processing significantly increased from the beginning to the midpoint of therapy. The results indicate that CBT clients are more distant and disengaged from their emotional experience than clients in PET. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Harmful supervision, a cause for alarm: Comment on Gray et al. (2001) and Nelson and Friedlander (2001).

The research presented by L. A. Gray, N. Ladany, J. A. Walker, and J. R. Ancis (2001) and by M. L. Nelson and M. L. Friedlander (2001) offers an important leap forward in understanding what contributes to problematic clinical supervision. First, to organize and extend this line of inquiry, the author proposes that a distinction be made between bad supervision (ineffective supervision that does not harm or traumatize the supervisee) and harmful supervision (supervision that harms or traumatizes; the supervisee). Second, the author highlights the data from the 2 studies that were found most striking and disquieting (e.g., a sizable portion of the respondents experienced harmful supervision) and discusses the implications of these data. Third, the author offers 5 recommendations for research, practice, and the psychology profession. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Lesson in Assigning Homework: Therapist, Client, and Task Characteristics in Cognitive Therapy for Depression.

The majority of professional psychologists use homework in clinical practice, at least on occasion. Are there ways of assigning and reviewing homework that contribute to better treatment outcomes? If so, are these strategies being incorporated into clinical practice? To help answer these questions, the authors used data from S. D. Hollon et al.'s (1992) Cognitive-Pharmacotherapy Treatment Project. Trained coders rated aspects of discussions between therapists (delivering cognitive therapy) and clients (N = 24) during the assignment and review of homework. The authors found that better treatment outcome was associated with specific therapist behaviors (i.e., setting concrete goals and discussing barriers to completing the homework), characteristics of the homework task (i.e., using written reminders of the homework), and client involvement in the discussion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Quality of Psychotherapy Case Formulations: A Comparison of Expert, Experienced, and Novice Cognitive-Behavioral and Psychodynamic Therapists.

Sixty-five expert, experienced, and novice cognitive-behavioral and psychodynamic psychotherapists provided "think aloud" case formulations in response to 6 standardized patient vignettes varying in disorder and prototypicality. The 390 formulations were reliably transcribed, segmented into idea units, content coded, and rated on multiple dimensions of quality. As hypothesized, the formulations of experts were more comprehensive, elaborated, complex, and systematic. Judges did not rate them as more coherent or precise in the use of language. In addition, the treatment plans of experts were more elaborated and linked better to the formulations. Effect sizes for overall ratings of quality ranged from medium to large. Few differences based on therapy orientation were observed. Results are discussed in terms of therapist training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gaining a Better Understanding of Peer Group Contributions to Dating Aggression-Implications for Prevention and Intervention Programming: Comment on Kinsfogel and Grych (2004).

K. M. Kinsfogel and J. H. Grych's (2004) article presents a theoretical model to examine the mechanisms by which interparental conflict is associated with adolescents' dating aggression. The study is noteworthy in its focus on the influence of less severe forms of interparental conflict than in most prior investigations, and in the attention it places on the peer group social context in understanding the subtleties of adolescents' intimate relationships. The study provides valuable information about the association between conflictual marital relations and dating aggression among male adolescents while highlighting the need for new models to understand the role of marital conflict in the expression of dating aggression among female adolescents. The study has important implications for partnering with male adolescents to design and adapt dating aggression programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homework in interpersonal psychotherapy (IPT): Rationale and practice.

Interpersonal therapy (IPT) is a time-limited therapy that was initially created for the treatment of major depressive disorder but has shown efficacy in other psychiatric disorders and a variety of populations. The present article is divided in two parts. The first part summarizes the structure, phases, and techniques of IPT and presents the four problem areas that are used as possible foci for the therapy. The second part presents the rational for use of homework and illustrates the use of homework in a variety of situations, with different types of patients suffering from acute and chronic forms of mood and anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metacognitive awareness and prevention of relapse in depression: Empirical evidence.

Metacognitive awareness is a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self. The authors hypothesized that (1) reduced metacognitive awareness would be associated with vulnerability to depression and (2) cognitive therapy (CT) and mindfulness-based CT (MBCT) would reduce depressive relapse by increasing metacognitive awareness. They found (1) accessibility of metacognitive sets to depressive cues was less in a vulnerable group (residually depressed patients) than in nondepressed controls; (2) accessibility of metacognitive sets predicted relapse in residually depressed patients; (3) where CT reduced relapse in residually depressed patients, it increased accessibility of metacognitive sets; and (4) where MBCT reduced relapse in recovered depressed patients, it increased accessibility of metacognitive sets. CT and MBCT may reduce relapse by changing relationships to negative thoughts rather than by changing belief in thought content. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance in two telephone-administered treatments: Relationship with depression and health outcomes.

The present study examined the relationship between therapeutic alliance and both depression and health outcomes in a randomized clinical trial of 2 telephone-administered treatments with 97 clients with multiple sclerosis (MS). The 16-week, manualized treatments compared were telephone-administered cognitive-behavioral therapy (T-CBT) and telephone-administered supportive emotion focused therapy (T-SEFT), an experiential treatment. Alliance scores were significantly higher in T-CBT compared with T-SEFT, and treatment moderated the relationship between alliance and outcome on some of the measures. Specifically, alliance predicted subsequent improvements in depression within the T-CBT condition, but not in T-SEFT, controlling for early symptom change. The authors found a similar trend for alliance and MS-related disability in T-CBT only. This is one of the first studies to examine the role of alliance in outcome for the emerging modality of telephone therapy and one of the few to relate alliance to health outcomes. The findings suggest that the therapist-client relationship is important to improvement in telephone therapy and that the role of alliance in outcome may vary by treatment approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The common factor of mindfulness--An expanding discourse: Comment on Horowitz (2002).

In an earlier article (J. R. Martin, 1997a), I proposed a common factor of mindfulness that can be found in all psychotherapy orientations. Mindfulness was defined as a state of psychological freedom that occurs when attention remains quiet and limber, without attachment to any particular point of view. In the present commentary, I explore some linkages between this common factor and M. J. Horowitz's (see record 2002-13441-001) ideas regarding self- and relational observation. His article offers several promising ideas for psychotherapy integration and the potential development of effective psychotherapy interventions. It also expands the discourse related to a mindfulness factor (J. R. Martin, 1997a) and its facets, linkages, and its implications for clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacological cognitive enhancers: Comment on Smith and Farah (2011).

Smith and Farah (2011) provided a thought-provoking and perhaps deliberately provocative literature review of the use of stimulants to improve cognitive functioning in humans. They addressed the apparently increasing willingness of individuals mostly in the United States to use stimulants for this purpose and then summarized published literature that explores whether stimulants actually improve specific aspects of neurocognitive function. Although calling for more research, they tentatively concluded that stimulants indeed may be “smart pills” for some people under certain circumstances. This comment emphasizes that they never actually defined the desired qualities of a smart pill, seemed to accept the unproven axiom that slight improvements in specific tests constitute meaningful enhancement of intelligence, and failed to consider the possible costs to individuals and to society of promoting the use of this class of medications for such a purpose. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Client concealment and self-presentation in therapy: Comment on Kelly (2000).

The authors disagree with A. E. Kelly's (see record 2000-08364-001) conclusions that clients conceal things from therapists primarily for self-presentational reasons and that client concealment is positively related to positive therapy process and outcome. They also disagree with A. E. Kelly regarding the implications of self-presentation theory for therapy. Their review of the research suggests that clients do not conceal much from therapists, that what they do conceal involves many different kinds of information hidden for many different reasons, that therapists have wide variability in being able to detect hidden client material, and that the relationship of client concealment and therapist awareness of client concealment with therapy process and outcome is not clear. Finally, the authors discuss their views about implications of client concealment and self-presentation for therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metaphors and models of executive functioning: Comment on Giancola (2000).

Clinical researchers have become increasingly interested in considering the role of normal and impaired executive functioning in psychopathology. The concept of executive functions is, however, often used as a metaphor for a wide range of operations that may, on the one hand, be distinct from one another, but also may be integrated in various ways under different information-processing conditions. A clinician's perspective of executive functioning should take full advantage of the rich body of data and theory that has developed in contemporary cognitive neuroscience around functions such as forms of inhibition and controlled (in contrast to automatic) functions, in a variety of cognitive domains such as making decisions and tracking performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are associative and propositional processes qualitatively distinct? Comment on Gawronski and Bodenhausen (2006).

The authors comment on B. Gawronski and G. V. Bodenhausen's (2006; see record 2006-10465-003) associative-propositional evaluation model of implicit and explicit attitudes by examining the claims that (a) truth value is attached to propositions but not to associations; (b) pattern activation is qualitatively different from syllogistic structure of arguments; and (c) Pavlovian conditioning may be propositional, whereas evaluative conditioning is not. They conclude that despite surface dissimilarities between implicit and explicit attitudes both may be mediated by the same underlying process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic Alliance and Treatment Adherence in Two Interventions for Bulimia Nervosa: A Study of Process and Outcome.

The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome variable. There were no significant therapist or Therapist × Treatment effects on outcome. Although results showed high levels of alliance and adherence across treatments, CBT was associated with greater adherence. Across treatments and time points, better adherence was associated with enhanced alliance. Treatment condition and baseline purging frequency, but not adherence, predicted outcome. Early alliance predicted posttreatment purging frequency. In temporal analyses, prior symptom change assessed early in treatment was significantly related to subsequent adherence at midtreatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues of measurement and mechanism in meta-analyses: Comment on Westen and Morrision (2001).

The authors suggest that D. Westen and K. Morrison's (2001) meta-analysis of treatment (see record 2001-05666-001) is critically limited in the consideration of measurement and mechanisms of therapeutic change. The measures included in the analysis fail to represent a comprehensive coverage of the domains within which change is expected. Moreover, they do not measure the theoretically derived constructs currently conceived as being central to each disorder. Further, the particular meta-analytical approach taken prohibits evaluation of the treatment components responsible for change. The authors reviewed the most recent data on comorbidity as an issue of treatment efficacy and generalizability, proffer an interpretation for the difference in outcome results across the 3 diagnostic groups, and discuss internally valid methodologies for the bridging from research to clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)