The relationship of patient and therapist-reported experiences of the initial session to outcome: An initial investigation.

Explored the impact of the initial psychotherapeutic session on outcome in 32 therapist–patient dyads. Ss were 18+ yrs old. Therapy consisted of a maximum of 8 sessions. The therapeutic interaction was assessed with selected portions of the Therapy Session Report, completed immediately after the first session by the participants. It was found that the patient's perception of the therapist's functioning during the first meeting related significantly to patient and therapist reports of symptom change subsequent to 4 sessions and length of treatment. In addition, there was a significant, linear decline in symptoms (reported by patient and therapist) after 8 therapy sessions. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of counselor touch in an initial counseling session.

32 17–25 yr old female clients were determined to be either field independent or dependent, using the Group Embedded Figures Test. During a counseling session in which vocational interest in teaching was discussed, Ss received 1 of 2 conditions. Ss in the touch condition received a total of 6 touches; Ss in the no-touch condition were not touched. After the session, Ss completed the State-Trait Anxiety Inventory, Self-Disclosure Questionnaire, and Counselor Rating Form. Ratings were also made of Ss' statements during the interview for actual self-disclosure. Results indicate that counselors were perceived as significantly more expert when they touched than when they did not. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of psychological therapies under clinically representative conditions: A meta-analysis.

Recently, concern has arisen that meta-analyses overestimate the effects of psychological therapies and that those therapies may not work under clinically representative conditions. This meta-analysis of 90 studies found that therapies are effective over a range of clinical representativeness. The projected effects of an ideal study of clinically representative therapy are similar to effect sizes in past meta-analyses. Effects increase with larger dose and when outcome measures are specific to treatment. Some clinically representative studies used self-selected treatment clients who were more distressed than available controls, and these quasi-experiments underestimated therapy effects. This study illustrates the joint use of fixed and random effects models, use of pretest effect sizes to study selection bias in quasi-experiments, and use of regression analysis to project results to an ideal study in the spirit of response surface modeling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing aversion to side effects in preventive medical treatment decisions.

Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by making it easier for respondents to determine how the treatment might change their net cancer risk. Participants (N=4,248) were presented with a hypothetical preventive treatment situation that was or was not accompanied by a small side effect. In both conditions, the net absolute risk reduction was 12%. Adding an array of stick figures to risk probabilities reduced side effect aversion substantially, but adding a bar graph was not beneficial. The ability of arrays to reduce side effect aversion was not attributable to greater accuracy in evaluating the treatment's net benefit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physicians' characteristics influence patients' adherence to medical treatment: Results from the Medical Outcomes Study.

Examined the influence of physicians' attributes and practice style on patients' adherence to treatment in a 2-yr longitudinal study of 186 physicians and their diabetes, hypertension, and heart disease patients. A physician-level analysis was conducted, controlling for baseline patient adherence rates and for patient characteristics predictive of adherence in previous analyses. General adherence and adherence to medication, exercise, and diet recommendations were examined. Baseline adherence rates were associated with adherence rates 2 yrs later. Other predictors were physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients' questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prescribing psychologists and patients' medical needs: Lessons from clinical psychiatry.

Psychologists who acquire prescribing privileges will assume an expanded obligation to address patients' medical (physical) conditions. Development of a training and practice model for prescribing psychologists may be informed by an awareness of how psychiatrists fulfill this obligation. Surveys of psychiatrists indicate that they rarely perform physical or neurological examinations. They typically participate only obliquely in the evaluation of patients presenting with acute behavioral or emotional symptoms suggesting organic illness, and they virtually never treat concomitant medical conditions of their patients. Other than in psychopharmacology, psychiatrists use their residual medical knowledge only indirectly. Findings imply that training for prescribing psychologists can be focused according to their expected clinical activities and that a model of practice emphasizing collaboration with nonpsychiatric physicians is feasible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Silent versus symptomatic myocardial ischemia: The role of psychological and medical factors.

This study examined the relationship of psychological, cardiac, and general medical history factors to asymptomatic (silent) versus symptomatic myocardial ischemia among 102 patients who underwent treadmill exercise testing and had perfusion imaging indicative of ischemia. During exercise, 68 patients exhibited silent ischemia, and 34 experienced chest pain. Patients with silent ischemia rated higher than symptomatic patients on anger control, externally oriented thinking, and somatosensory amplification, but did not differ on depression or global alexithymia. Anger control and externally oriented thinking remained independent correlates in multivariate analysis, controlling for demographic and cardiac factors. Groups did not differ on general medical or cardiac variables. Thus, this study suggests that affective and cognitive factors, but not biomedical factors, are associated with silent, as opposed to symptomatic, ischemia during exercise testing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinician interventions related to alliance during the initial interview and psychological assessment.

The present review is a comprehensive examination of therapist interventions and characteristics that have been found to positively influence the therapeutic alliance during the psychological assessment or initial interview. A major purpose of this review is to link empirically defined interventions found in the research literature to applied clinical practice so that clinicians from a broad range of perspectives can use these techniques to potentially improve their working relationships with clients during the assessment process. Specific therapist activities and attitudes highlighted by contemporary psychotherapy research are discussed and summarized. A general outline for organizing a pretherapy assessment based on the findings of this review is also provided. In addition, the research reviewed provides no compelling evidence to suggest that different practitioners should conduct the assessment and psychotherapy. Finally, there is some limited evidence to suggest that training initiatives may be helpful with regard to increasing a therapist's abilities to strengthen the alliance, and further research in this area is warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protease inhibitors and the new AIDS combination therapies: Implications for psychological services.

Practicing psychologists face many challenges in caring for people living with HIV infection, including keeping abreast of new treatments and their impact on the psyche. Highly active antiretroviral therapies, which include protease inhibitors, demand particularly strict adherence to cumbersome treatment regimens, potentially interact with psychotropic medications, are not universally accessible, and may lower vigilance against AIDS. The promises of new treatments are also not always realized, and treatment failures pose significant psychological ramifications. In keeping pace with the ever-changing AIDS epidemic, psychologists and counselors should be aware of the promises and the realities of advances in medical treatments for HIV infection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in medical problems and use of medical services following psychological intervention.

Important life changes and significant psychological stress occur before, during, and after episodes of physical illness in the lives of many individuals. Significant life-adjustment or developmental difficulties have been shown to be associated with high use of medical services. This article discusses the reduction in medical problems and use of medical facilities with referral for psychological services. On the assumption that psychologists can contribute significantly to reduction in patients' psychological stress levels and associated physical complaints, a new self-image for many psychologists could be that of health care professional. Furthermore, this self-image and role could be implemented by having psychologists contribute to the treatment of patients in a continuous manner, starting with the initial patient visit to a health care facility. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The study of intoxicant use and misuse in psychological and medical education: A basic curriculum.

Discusses factors responsible for the previous neglect of substance abuse by health care professions and describes changes that have made it possible to include this field in clinical education and training. Various factors contributed to the neglect of substance abuse, including the social, psychological, and political distance between clinicians and those with intoxicant problems; the disruptive impact of early psychoanalytic thinking; and clinicians' lack of faith in the efficacy of treatment. As a more treatment-oriented group developed intoxicant problems, treatment facilities and techniques improved, leading to a greater optimism about outcome among clinicians. These and other changes make further education in this field feasible and desirable. A sample curriculum is presented for a full year's course of 26 2-hr seminars on this topic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work-related stress and psychological distress in emergency medical technicians.

Emergency medical technicians (n?=?65) participated in a study on work environment characteristics, work-related stress, and psychological distress. Data were collected at baseline and 6 months. Work-related stress was associated with lower work group support and poor supervisory behavior. Work-related stress was strongly related to psychological distress. Changes in work-related stress were significantly related to changes in psychological distress. Findings support the work-related stress, psychological distress model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Service profiling and outcomes benchmarking using the CORE-OM: Toward practice-based evidence in the psychological therapies.

To complement the evidence-based practice paradigm, the authors argued for a core outcome measure to provide practice-based evidence for the psychological therapies. Utility requires instruments that are acceptable scientifically, as well as to service users, and a coordinated implementation of the measure at a national level. The development of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is summarized. Data are presented across 39 secondary-care services (n?=?2,710) and within an intensively evaluated single service (n?=?1,455). Results suggest that the CORE-OM is a valid and reliable measure for multiple settings and is acceptable to users and clinicians as well as policy makers. Baseline data levels of patient presenting problem severity, including risk, are reported in addition to outcome benchmarks that use the concept of reliable and clinically significant change. Basic quality improvement in outcomes for a single service is considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resolving intractable medical problems through psychological intervention: A clinical report.

Presents the case study of a 27-yr-old female admitted to a national asthma center for a complex of respiratory problems that had defied medical intervention. Hypnotic techniques and insight-oriented psychotherapy resulted in hospital release with only the asthma problem remaining after 4 mo. Psychotherapy continued for 5 more months. Hypnotic technique allowed S to recover control and reverse the chain of intractable events in the course of her illness. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The medical aspects in the psychological training of the troops

A study of psychological training methods tested on 318 servicemen--armed conflicts participants, including 22 military doctors, veterans of Afghanistan. The results of the research prove that various departures in psychological traits are highly relevant to extreme situations and that a psychological training programme for the medical service personnel is a necessity. The development of the programme should be based on the troops medical maintenance experience in the armed conflicts.     

Spouses' use of pressure and persuasion to promote osteoarthritis patients' medical adherence after orthopedic surgery.

Objective: The authors investigated health-related effects of social control (influence) that spouses exert in relation to osteoarthritis patients' medical adherence after total knee replacement surgery. Patients' behavioral and emotional responses to control were examined as mediators of associations between spouses' use of two control strategies (pressure, persuasion) and patients' physical and psychological recovery. Design: The authors used a three-wave panel design with assessments at one month before surgery, 1 month and 3 months after surgery. Data were collected during in-person interviews with 70 married, older adult patients. Main Outcome Measures: Recovery outcomes were assessed as improvement in knee limitations and depressive symptoms at the 3 month follow-up. Results: Spousal pressure and persuasion at one month postsurgery were indirectly associated with patients' recovery outcomes through patients' positive emotional responses to control. Conclusion: Although there are often immediate behavioral benefits in response to partners' use of both pressure and persuasion, the long-term health effects of these strategies seem to be accounted for by their opposing links to positive emotions. Findings further refine theory on health-related social control in marriage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The secure-base hypothesis: Global attachment, attachment to counselor, and session exploration in psychotherapy.

This study explored J. Bowlby's (1988) secure-base hypothesis, which predicts that a client's secure attachment to the therapist, as well as the client's and the therapist's global attachment security, will facilitate in-session exploration. Volunteer clients (N = 59) and trainee counselors (N = 59) in short-term therapy completed the Experiences in Close Relationship Scale (K. A. Brennan, C. L. Clark, & P. R. Shaver, 1998) as a measure of adult global romantic and peer attachment orientations; the Client Attachment to Therapist Scale (B. Mallinckrodt, D. L. Gantt, & H. M. Coble, 1995) as a measure of attachment to counselor; the Working Alliance Inventory (A. O. Horvath & L. Greenberg, 1989) as a measure of working alliance; and the Session Evaluation Questionnaire-Depth Subscale (W. B. Stiles & J. S. Snow, 1984) as a measure of session depth. In line with Bowlby's hypothesis, the findings suggest that session depth is related to the client's experience of attachment security with the counselor and that counselor global attachment moderates the relationship between client global attachment and session exploration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost effectiveness and medical cost-offset considerations in psychological service provision.

Suggests that empirical evidence has demonstrated that psychological interventions can effectively treat a wide range of child and adult health problems. The focus of this review is on costing issues associated with psychological interventions, including cost-effectiveness and cost offset (i.e., a reduction in health care costs attributable to effective intervention). Recent evidence has demonstrated that psychological interventions can be more cost-effective than optimal drug treatment. For example, although having comparable effectiveness, cognitive-behavioral treatments for panic disorder and for depression have been estimated to cost approximately one-third less than pharmacological treatment. Further, a recent meta-analysis of 91 research studies published between 1967 and 1997 found that average health care cost savings due to psychological intervention were in the range of 20-30% across studies, and 90% of the studies reported evidence of a medical cost offset. In conclusion, the evidence indicates that psychological treatments (1) can be cost-effective forms of treatment and (2) have the potential to reduce health care costs, as successfully treated patients typically reduce their utilization of other health care services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)