Implementation of an evidence-based practice in a clinical setting: What happens when you get there?

Great strides have been made in creating and testing evidence-based practices (EBPs). However, without adequate dissemination and implementation in clinical settings, this progress is of limited value. This article describes the implementation of an EBP (e.g., cognitive–behavioral therapy for depression and anxiety) in a large-group practice mental health services delivery system, focusing on both the role of psychologists and on the training model developed for implementation. The experience in implementation of an EBP is reviewed, with an emphasis on the role and direction psychologists might take in engaging and developing EBP training programs for other mental health services delivery systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural dimensions of intersubjectivity: Negotiating “sameness” and “otherness” in the analytic relationship.

The cultural diversity of Western society has created an increasingly complex psychoanalytic intersubjective field. Cultural, class, racial, and familial dimensions of experience can never be separated in the psyche of the patient or analyst or in the analytic relationship. But the melding of these influences results in particular meanings for each patient, analyst, and analytic couple, and may be crucial to address for authentic connection and change to occur. A clinical case is presented in which uniquely melded cultural, class, and psychological meanings became enacted between patient and analyst, stimulating unexpected feelings in both, which enabled the emergence of a bridge across an apparent gulf of “otherness.” (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

“Everyone knows their Miranda rights”: Implicit assumptions and countervailing evidence.

In its landmark decision in Miranda v. Arizona (1966), the Supreme Court of the United States buttressed the Constitutional privilege against self-incrimination by requiring as a procedural safeguard that various aspects of this privilege be clearly communicated to custodial suspects. Members of the public often believe that their continually media-fueled familiarity with Miranda warnings results in an adequate understanding of Miranda rights—a frequently erroneous assumption that may diminish counsel's motivation to investigate Miranda waivers and may influence court rulings on the validity of such waivers. The current investigation examined Miranda rights misconceptions held by two groups of pretrial defendants: those arrested more recently (i.e., less than 2 weeks ago) and those arrested less recently (i.e., 4 weeks ago or more). The misconceptions of these groups were then contrasted with those of undergraduate students representing a more educated and comparatively unstressed segment of American society. Results revealed a host of widely-held misconceptions, including a fundamental misunderstanding of the function of the “right to remain silent” as a legal protection. Moreover, many misconceptions appeared unrelated to intelligence, education, or prior contacts with the criminal justice system. The implications of these findings are discussed with respect to the validity of Miranda waivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

“Progress monitoring in oral reading fluency within the context of RTI”: Correction.

Reports an error in "Progress monitoring in oral reading fluency within the context of RTI" by Amy-Jane Griffiths, Amanda M. VanDerHeyden, Mary Skokut and Elena Lilles (School Psychology Quarterly, 2009[Mar], Vol 24[1], 13-23). The slopes reported in text were incorrect. The correct information is as follows: The average slope across the four measurement occasions for students who had a successful RTI on the familiar passage was 8.98 wc/min per week and on the novel passage was 2.06 wc/min per week. The average slope for students who had an unsuccessful RTI was 4.6 wc/min per week on the familiar passage and -1.5 wc/min per week on the novel passage. These values were correctly depicted in Figure 1. (The following abstract of the original article appeared in record 2009-03189-002.) Selecting appropriate measures to make decisions about child response to intervention is a key concern. The most commonly used assessment tool in response to intervention (RTI) models is curriculum-based measurement (CBM). However, an issue related to the use of CBM is the identification of measures that are of similar difficulty. To the degree that variation in performance across measurement occasions can be attributed to anything other than student learning, errors in judgment about student RTI may be made. The purpose of this study was to examine the accuracy and efficiency of using a single CBM passage for progress monitoring at key intervals during individual reading intervention compared to using several passages that had been individually equated. Results indicated that decisions made based on a standard passage did not differ from decisions made based on scores obtained on the individually equated passages but were much more cost efficient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What are the benefits of mindfulness? A practice review of psychotherapy-related research.

Research suggests that mindfulness practices offer psychotherapists a way to positively affect aspects of therapy that account for successful treatment. This paper provides psychotherapists with a synthesis of the empirically supported advantages of mindfulness. Definitions of mindfulness and evidence-based interpersonal, affective, and intrapersonal benefits of mindfulness are presented. Research on therapists who meditate and client outcomes of therapists who meditate are reviewed. Implications for practice, research, and training are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The “me” I claim to be: Cultural self-construal elicits self-presentational goal pursuit.

In 12 studies, respondents with an independent (vs. interdependent) self-construal showed an increased tendency and readiness to present themselves as skillful and capable and a decreased tendency and readiness to present themselves as socially sensitive and appropriate. This emerged in the form of differential scores on direct measures of self-presentation—self-deceptive enhancement and impression management (Study 1), differential social sensitivity in a gift-giving scenario (Study 2), differential performance on questions assessing general knowledge (Studies 5–6) and etiquette (Studies 7–8), and different choices between tests purportedly measuring one’s self-reliance versus social-appropriateness (Studies 9A and 9D). These relationships were observed when participants focused on their own self-presentational concerns but disappeared when participants focused on others’ outcomes (Study 3) or when they had a prior opportunity to satisfy their goals via self-affirmation (Studies 4, 5, 6, 7, 8, 9B, 9D). Finally, self-construal effects were eliminated or reversed when participants were led to doubt their ability to achieve their self-presentational goals (Study 9C). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arousing primary vulnerable emotions in the context of unresolved anger: “Speaking about” versus “speaking to”.

Arousing and processing primary vulnerable emotions is a core change mechanism across a wide range of psychotherapies and clinical populations. This study examined the utility of 2 emotion-focused interventions—relational reframes and empty-chair enactments—in terms of arousing primary sadness associated with loss and longing among individuals suffering from unresolved anger. Twenty-nine women reporting unresolved anger underwent a single, analogue emotion-focused therapy session comprised of empathy, relational reframe, and empty-chair interventions. The arousal of sadness was measured with voice signal, voice quality, and speech fluency measures. Results indicated that both relational reframe and empty-chair interventions led to increased arousal of sadness relative to baseline nonemotional speech. Empty-chair interventions also led to increases in fear/anxiety, presumably due to the potential for rejection or attack by the significant other (i.e., attachment figure). Treatment implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evolving vocabulary of the social sciences: The case of “socialization”.

While the term “socialization” stands as a common and clearly understood term regularly used in social science and lay conversations alike, its history is complex. In the 19th century, socialization was introduced to refer to societal activities or projects, and only in the early 20th century did it gain usage as a term describing psychological processes transpiring within the individual. The architecture of the newer meaning harbored ambitions and problems of modern social science, including ideals of interdisciplinary theory and theoretic resolution of the individual/society dualism. Nevertheless, socialization became a central object of social scientific inquiry after World War II. This significant social scientific object was repeatedly altered: initially representing a vision of conforming citizens who were free from certain troubling characteristics depicted in psychoanalysis and well-suited to democracy, it later was engaged to create a vision of autonomous, resilient, and cognitively active actors able to negotiate a complex social world. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Rational learning and information sampling: On the “naivety” assumption in sampling explanations of judgment biases.

Recent research has argued that several well-known judgment biases may be due to biases in the available information sample rather than to biased information processing. Most of these sample-based explanations assume that decision makers are “naive”: They are not aware of the biases in the available information sample and do not correct for them. Here, we show that this “naivety” assumption is not necessary. Systematically biased judgments can emerge even when decision makers process available information perfectly and are also aware of how the information sample has been generated. Specifically, we develop a rational analysis of Denrell's (2005) experience sampling model, and we prove that when information search is interested rather than disinterested, even rational information sampling and processing can give rise to systematic patterns of errors in judgments. Our results illustrate that a tendency to favor alternatives for which outcome information is more accessible can be consistent with rational behavior. The model offers a rational explanation for behaviors that had previously been attributed to cognitive and motivational biases, such as the in-group bias or the tendency to prefer popular alternatives. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Seeing a phrase “time and again” matters: The role of phrasal frequency in the processing of multiword sequences.

Are speakers sensitive to the frequency with which phrases occur in language? The authors report an eye-tracking study that investigates this by examining the processing of multiword sequences that differ in phrasal frequency by native and proficient nonnative English speakers. Participants read sentences containing 3-word binomial phrases (bride and groom) and their reversed forms (groom and bride), which are identical in syntax and meaning but that differ in phrasal frequency. Mixed-effects modeling revealed that native speakers and nonnative speakers, across a range of proficiencies, are sensitive to the frequency with which phrases occur in English. Results also indicate that native speakers and higher proficiency nonnatives are sensitive to whether a phrase occurs in a particular configuration (binomial vs. reversed) in English, highlighting the contribution of entrenchment of a particular phrase in memory. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Against the grain: “Matter” and “spirit”.

Comments on the original article, Implications of near-death experiences for a postmaterialist psychology, by B. Greyson (see record 2010-03251-005). Although I will only comment on the paper by Greyson (2010), my initial thoughts pertain to the whole section, which explicitly framed itself as a repudiation of materialism and a defense of spiritual psychology. I find neither of these positions palatable or fair to the nature of reality, which seems to scoff at our pedestrian attempts to tame it, whether by crass materialism or spiritualism. Both “spiritual materialism” and “crass materialism” are but different manifestations of the same maladies: The refusal to consider data that do not fit preconceptions (i.e., that one’s beliefs, whether spiritual or “scientistic” may be wrong or, at least, incomplete), methodological poverty (i.e., that one’s method of knowledge, whether experiential or experimental is the only or the best way to apprehend all of reality), and philosophical shallowness (e.g., the “secret” that we attract what happens to us, which is an insult to the countless victims of genocides and brutalities throughout history, or the pronouncements that consciousness has been “explained” when we have no idea even how electrochemical impulses become experiences). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

“Sources of social support and burnout: A meta-analytic test of the conservation of resources model”: Correction.

Reports an error in Sources of social support and burnout: A meta-analytic test of the conservation of resources model by Jonathon R. B. Halbesleben (Journal of Applied Psychology, 2006[Sep], Vol 91[5], 1134-1145). There were errors in transcribing the ρ values from Table 2 to the results section. In the second paragraph of page 1138, the second and third sentences should read “In the present study, work-related support was more strongly related to exhaustion (ρ = -.26) than depersonalization (ρ = -.23) and personal accomplishment (ρ = .24; F(2, 111) = 24.13, p > .01). On the other hand, non-work support was more strongly related to depersonalization (ρ = -.16) and personal accomplishment (ρ = .19) than exhaustion (ρ = -.12; F(2, 38) = 3.83, p > .05).” The values in Table 2 are correct and the substantive conclusions have not changed. (The following abstract of the original article appeared in record 2006-11397-012.) The Conservation of Resources (COR) model of burnout (Hobfoll & Freedy, 1993) suggests that resources are differentially related to burnout dimensions. In this paper, I provide a meta-analysis of the social support and burnout literature, finding that social support, as a resource, did not yield different relationships across the 3 burnout dimensions (emotional exhaustion, depersonalization, and personal accomplishment), challenging the COR model. However, when considering the source of the social support (work vs. nonwork) as a moderator, I found that work-related sources of social support, because of their more direct relationship to work demands, were more closely associated with exhaustion than depersonalization or personal accomplishment; the opposite pattern was found with nonwork sources of support. I discuss the implications of this finding in relation to the COR model and suggest future research directions to clarify the relationship between resources and burnout dimensions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies.

The efficacy of cognitive–behavioral therapy (CBT) for anxiety in adults is well established. In the present study, the authors examined whether CBT tested under well-controlled conditions generalizes to less-controlled, real-world circumstances. Fifty-six effectiveness studies of CBT for adult anxiety disorders were located and synthesized. Meta-analytic effect sizes are presented for disorder-specific symptom measures as well as symptoms of generalized anxiety and depression for each disorder, and benchmarked to results from randomized controlled trials. All pretest–posttest effect sizes for disorder-specific symptom measures were large, suggesting that CBT for adult anxiety disorders is effective in clinically representative conditions. Six studies included a control group, and between-groups comparisons yielded large effect sizes for disorder-specific symptoms in favor of CBT. Benchmarking indicated that results from effectiveness studies were in the range of those obtained in selected efficacy trials. To test whether studies that are more representative of clinical settings have smaller effect sizes, the authors coded studies for 9 criteria for clinical representativeness. Results indicate an inverse relationship between clinical representativeness and outcome, but the magnitude of the relationship is quite small. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Electrochemical recovery of rhenium from W–Re alloys in the form of perrhenic acid: I. Fundamentals of the process

Linear voltammetry is used to study the anodic behavior of a VR20 alloy in sodium hydroxide solutions, and the possibility of high-rate dc electrochemical dissolution of this alloy is shown. Experimental dependences of the rate of alloy dissolution and the anode current efficiency on the anode current density are determined, and the electric power consumed for alloy dissolution under optimum conditions is determined in large-scale tests. Potassium perrhenate is removed from the formed electrolyte as an intermediate product to form perrhenic acid. The main characteristics of the electrodialysis conversion of the synthesized potassium perrhenate into perrhenic acid with a concentration of 591 g/L electrolyte are determined. A technological scheme is proposed for the recovery of rhenium from the wastes of a W–Re alloy in the form of perrhenic acid.     

Conceptual structure and social functions of behavior explanations: Beyond person–situation attributions.

The traditional approach to studying behavior explanations involves treating them as either person causes or situation causes and assessing them by using rating scales. An analysis of people's free-response behavior explanations reveals, however, that the conceptual distinctions people use in their explanations are more complex and sophisticated than the person-situation dichotomy suggests. The authors, therefore, introduce a model of the conceptual structure of folk behavior explanations (the network of concepts and assumptions on which explanations are based) and test it in 4 studies. The modes and features of behavior explanations within this conceptual structure also have specific social functions. In 2 additional studies, the authors demonstrate that people alter distinct features of their explanations when pursuing particular impression-management goals and that listeners make inferences about explainers' goals on the basis of these features. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The “good” limb makes the “bad” limb worse: Experience-dependent interhemispheric disruption of functional outcome after cortical infarcts in rats.

Following stroke-like lesions to the sensorimotor cortex in rats, experience with the ipsi-to-lesion (ipsilesional), “nonparetic”, forelimb worsens deficits in the contralesional, “paretic”, forelimb. We tested whether the maladaptive effects of experience with the nonparetic limb are mediated through callosal connections and the contralesional sensorimotor cortex. Adult male rats with proficiency in skilled reaching with their dominant (for reaching) forelimb received ischemic bilateral sensorimotor cortex lesions, or unilateral lesions, with or without callosal transections. After assessing dominant forelimb function (the paretic forelimb in rats with unilateral lesions), animals were trained with their nonparetic/nondominant forelimb or underwent control procedures for 15 days. Animals were then tested with their paretic/dominant forelimb. In animals with unilateral lesions only, nonparetic forelimb training worsened subsequent performance with the paretic forelimb, as found previously. This effect was not found in animals with both callosal transections and unilateral lesions. After bilateral lesions, training the nondominant limb did not worsen function of the dominant limb compared with controls. Thus, the maladaptive effects of training the nonparetic limb on paretic forelimb function depend upon the contralesional cortex and transcallosal projections. This suggests that this experience-dependent disruption of functional recovery is mediated through interhemispheric connections of the sensorimotor cortex. (PsycINFO Database Record (c) 2010 APA, all rights reserved)