Unique and common mechanisms of change across cognitive and dynamic psychotherapies.

The goal of this article was to examine theoretically important mechanisms of change in psychotherapy outcome across different types of treatment. Specifically, the role of gains in self-understanding, acquisition of compensatory skills, and improvements in views of the self were examined. A pooled study database collected at the University of Pennsylvania Center for Psychotherapy Research, which includes studies conducted from 1995 to 2002 evaluating the efficacy of cognitive and psychodynamic therapies for a variety of disorders, was used. Patient samples included major depressive disorder, generalized anxiety disorder, panic disorder, borderline personality disorder, and adolescent anxiety disorders. A common assessment battery of mechanism and outcome measures was given at treatment intake, termination, and 6-month follow-up for all 184 patients. Improvements in self-understanding, compensatory skills, and views of the self were all associated with symptom change across the diverse psychotherapies. Changes in self-understanding and compensatory skills across treatment were predictive of follow-up symptom course. Changes in self-understanding demonstrated specificity of change to dynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Treating the juvenile offender.

Reviews the book, Treating the juvenile offender edited by Robert D. Hoge, Nancy G. Guerra, and Paul Boxer (see record 2008-02979-000). This book rejuvenates interest in treatment for juvenile offenders, outlining the important advances that have been made, key challenges that remain, and useful principles for effectively meeting these challenges. Key themes that are emphasised include the importance of evidence-based approaches, interventions that are sensitive to the ecological systems within which youth are embedded, and rehabilitative strategies that are closely informed by research on youths’ risks, needs, and strengths. This book does not deliver a quick manual on how to deliver a particular program, but instead carefully models how to think about and approach treatment. While the book remains accessible to beginners, it is written in a manner which will be thought-provoking and informative even for experts. Furthermore, it is likely to have the positive effect of leaving readers with a desire to learn and do more to improve current practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A practical clinical trial of coordinated care management to treat substance use disorders among public assistance beneficiaries.

This study tested whether coordinated care management (CCM), a continuity of care intervention for substance use disorders (SUD), improved rates of abstinence when compared with usual welfare management for substance-using single adults and adults with dependent children applying for public assistance. The study was designed as a practical clinical trial and was implemented in partnership with a large city welfare agency. Participants were 421 welfare applicants identified via SUD screening and assigned via an unbiased computerized allocation program to a site that provided either CCM (n = 232) or usual care (UC; n = 189). Outcomes were assessed for 1 year postbaseline with self-reports and biological measures of substance use. As hypothesized, for participants not enrolled in methadone maintenance programs (n = 313), CCM clients received significantly more services than did UC clients. Nonmethadone CCM also showed significantly higher abstinence rates (odds ratio = 1.75; 95% confidence interval = 1.12, 2.76; d = 0.31) that emerged early in treatment and were sustained throughout follow-up. In contrast, no treatment services or outcome effects were found for methadone maintenance clients (n = 108). Findings suggest that CCM is promising as a wraparound to SUD treatment for welfare recipients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brain fMRI reactivity to smoking-related images before and during extended smoking abstinence.

[Correction Notice: An erratum for this article was reported in Vol 18(3) of Experimental and Clinical Psychopharmacology (see record 2010-11933-011). In the article the authors find it necessary to redefine the thresholding procedure used for data analyses, due to problems in the Brain Voyager software. This does not affect the main findings of the paper.] Reactivity to smoking-related cues may play a role in the maintenance of smoking behavior and may change depending on smoking status. Whether smoking cue-related functional MRI (fMRI) reactivity differs between active smoking and extended smoking abstinence states currently is unknown. We used fMRI to measure brain reactivity in response to smoking-related versus neutral images in 13 tobacco-dependent subjects before a smoking cessation attempt and again during extended smoking abstinence (52 ± 11 days) aided by nicotine replacement therapy. Prequit smoking cue induced fMRI activity patterns paralleled those reported in prior smoking cue reactivity fMRI studies. Greater fMRI activity was detected during extended smoking abstinence than during the prequit assessment subcortically in the caudate nucleus and cortically in prefrontal (BA 6, 9, 44, 46), primary somatosensory (BA 1, 2, 3), temporal (BA 22, 41, 42), parietal (BA 7, 40) anterior cingulate (BA 24, 32), and posterior cingulate (BA 31) cortex. These data suggest that during extended smoking abstinence, fMRI reactivity to smoking versus neutral stimuli persists in brain areas involved in attention, somatosensory processing, motor planning, and conditioned cue responding. In some brain regions, fMRI smoking cue reactivity is increased during extended smoking abstinence in comparison to the prequit state, which may contribute to persisting relapse vulnerability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Design and Evaluation of a Computerized and Physical Simulator for Training Clinical Prostate Exams

The most effective screening for prostate cancer combines the prostate specific antigen blood test with the digital rectal examination (DRE). In performing a DRE, two sequential tasks are completed: ( task a) palpating the prostate to identify abnormalities and ( task b) linking identified abnormalities to a disease diagnosis. At present, clinicians find too few abnormalities and have variable rates of detection, due in part to the inadequacy of training simulators. The Virginia Prostate Examination Simulator (VPES) was designed, built, and tested to address the inadequacies of current simulators by incorporating the design requirements of the basic elements of accurate anatomy, multiple and reconfigurable scenarios of graded difficulty, and technique and performance feedback. We compared the training effectiveness of the VPES with two commercial simulators in an experiment of 36 medical and nurse practitioner students. Results indicate each type of training simulator-improved abilities, in general. Upon closer analysis, however, the following key patterns emerge: 1) Across all types of training, more deficiencies lie in skill-based rather than rule-based decision making, which improves only for VPES trainees; 2) only VPES training transfers both to other simulators and previously unencountered scenarios; 3) visual feedback may increase the number of abnormalities reported yet hinder the ability to discriminate; and 4) applied finger pressure did not correlate with the ability to identify abnormalities.      

Warm homes: Drivers of the demand for heating in the residential sector in New Zealand

New Zealand houses are large, often poorly constructed and heated, by OECD standards, and consequently are colder and damper indoors than recommended by the World Health Organisation. This affects both the energy consumption and the health of households. The traditional New Zealand household pattern of only heating one room of the house has been unchanged for decades, although there has been substantial market penetration of unflued gas heaters and more recently heat pumps. This paper describes the residential sector and the results of two community-based trials of housing and heating interventions that have been designed to measure the impact of (1) retrofitting insulation and (2) replacing unflued gas heaters and electric resistance heaters with heat pumps, wood pellet burners and flued gas heaters. The paper describes findings on the rebound effect or ‘take-back’—the extent to which households take the gains from insulation and heating improvements as comfort (higher temperatures) rather than energy savings, and compares energy-saving patterns with those suggested by an earlier study. Findings on these aspects of household space heating are discussed in the context of the New Zealand government's policy drive for a more sustainable energy system, and the implications for climate change policy.     

Establishing stability: exploring the meaning of ‘home’ for women who have experienced intimate partner violence

There is evidence that involuntary housing instability may undermine health and well-being. For women who have experienced intimate partner violence (IPV), achieving stability is likely as important for other groups, but can be challenging. Through our analysis of 41 interviews with women who have experienced low income and IPV, we argue that definitions of housing stability are multifaceted and for many centred on a shared understanding of the importance of creating an environment of “home”. We found that obtaining housing that satisfied material needs was important to women. However, in asking women to define what housing stability meant to them, we found that other factors related to ontological security and the home, such as safety, community, and comfort, contributed to women’s experiences of stability. Through our discussion of the importance these women placed on establishing stable homes, we argue that future research on women’s experiences with housing stability and IPV should include definitions of stability that capture both material security and women’s experiences with building emotionally stable homes.