Clin Psychol Research Articles

CBT and CFT for Chronic Pain.

Purpose of ReviewChronic pain is a widespread public and physical health crisis, as it is one of the most common reasons adults seek medical care and accounts for the largest medical reason for disability in the USA (Glombiewski et al., J Consult Clin Psychol. 86(6):533-545, 2018; Schemer et al., Eur J Pain. 23(3):526-538, 2019). Chronic pain is associated with decreased functional status, opioid dependence and substance abuse disorders, mental health crises, and overall lower perceived quality of life (Korff et al., J Pain. 17(10):1068-1080, 2016). For example, the leading cause of chronic pain and the leading cause of long-term disability is low back pain (LBP) (Bjorck-van Dijken et al. J Rehabil Med. 40:864–9, 2008). Evidence suggests that persistent low back pain (pLBP) is a multidimensional biopsychosocial problem with various contributing factors (Cherkin et al., JAMA. 315(12):1240-1249, 2016). Emotional distress, pain-related fear, and protective movement behaviors are all unhelpful lifestyle factors that previously were more likely to go unaddressed when assessing and treating patient discomfort (Pincus et al., Spine. 38:2118–23, 2013). Those that are not properly assisted with these psychosocial issues are often unlikely to benefit from treatment in the primary care setting and thus are referred to multidisciplinary pain rehabilitation physicians. This itself increases healthcare costs, and treatments can be invasive and have risks of their own. Therefore, less expensive and more accessible management strategies targeting these psychosocial issues should be started to facilitate improvement early. As a biopsychosocial disorder, chronic pain is influenced by a range of factors including lifestyle, mental health status, familial culture, and socioeconomic status. Physicians have moved toward multi-modal pain approaches in order to combat this public health dilemma, ranging from medications with several different mechanisms of action, lifestyle changes, procedural pain control, and psychological interventions (Fashler et al., Pain Res Manag. 2016:5960987, 2016). Part of the rehabilitation process now more and more commonly includes cognitive behavioral and cognitive functional therapy. Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior.Recent FindingsCFT differs from CBT functionally, as instead of improving managing/coping mechanisms of pain control from a solely mental approach, CFT directly points out maladaptive behaviors and actively challenges the patient to change them in a cognitively integrated, progressive overloading functional manner (Bjorck-van Dijken et al. J Rehabil Med. 40:864–9, 2008). This allows CFT to be targeted to each individual patient, with the goal of personalized reconceptualization of the pain response. The end goal is to overcome the barriers that prevent functional status improvement, a healthy lifestyle, and reaching their personal goals.SummaryChronic pain is a major public health issue. Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior.

Note: Marino, L., Lilienfeld, S.O. Third time's the charm or three strikes you're out? An updated review of the efficacy of dolphin‐assisted therapy for autism and developmental disabilities. J Clin Psychol. 1–15 (2021). https://doi.org/10.1002/jclp.23110

Journal of Clinical PsychologyVolume 77, Issue 6 p. 1514-1514 NOTEFree Access Note: Marino, L., Lilienfeld, S.O. Third time's the charm or three strikes you're out? An updated review of the efficacy of dolphin-assisted therapy for autism and developmental disabilities. J Clin Psychol. 1–15 (2021). https://doi.org/10.1002/jclp.23110 This note refers to this article: Third time's the charm or three strikes you're out? An updated review of the efficacy of dolphin-assisted therapy for autism and developmental disabilities Lori Marino, Scott O. Lilienfeld, Volume 77Issue 6Journal of Clinical Psychology pages: 1265-1279 First Published online: January 22, 2021 First published: 16 March 2021 https://doi.org/10.1002/jclp.23132Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL The editor publishes this note to make explicit that the editor and journal team agreed to publish this paper after careful peer review and consideration (https://doi.org/10.1002/jclp.23110). The editor publishes this note to add transparency to the potential conflict of interest raised by the authors' affiliations as reported by the authors. Based on the evidence provided to the editor and the journal team, the editor considers that this potential conflict of interest has not had any material impact on the quality or objectivity of the Marino and Lilienfeld article. REFERENCE Marino, L., Lilienfeld, S.O. (2021). Third time's the charm or three strikes you're out? An updated review of the efficacy of dolphin-assisted therapy for autism and developmental disabilities. J Clin Psychol., 1–15. https://doi.org/10.1002/jclp.23110 Citing Literature Volume77, Issue6June 2021Pages 1514-1514 ReferencesRelatedInformation

The prevalence and clinical characteristics of restless legs syndrome in patients with iron deficiency anemia in Korea.

While the prevalence and clinical characteristics of restless legs syndrome (RLS) are known to vary according to ethnicity, a detailed evaluation of this condition among patients with iron deficiency anemia (IDA) has not yet been reported in an Asian population. We investigated the prevalence and clinical characteristics of RLS in patients with IDA in Korea compared with age- and sex-matched patients diagnosed with idiopathic RLS. This prospective single-center study was performed at a regional university hospital. Consecutive patients with IDA were enrolled over a 4-year period. Clinical interviews and laboratory tests were conducted at the first visit. RLS diagnosis was confirmed through face-to-face interviews. We randomly selected patients with idiopathic RLS without comorbid medical disorders from our sleep center dataset as control patients. The clinical characteristics of both groups were compared. We enrolled 124 patients with IDA. Fifty (40.3%) patients were diagnosed with RLS, with 82% exhibiting severe to very severe symptoms. Patients with IDA and RLS were older and reported more sleep deterioration than patients with IDA without RLS. Patients with IDA and RLS also had a more depressed mood and higher periodic limb movement index scores than patients with idiopathic RLS. The prevalence of RLS among patients with IDA in Korea was high, with the majority having severe to very severe symptoms. Patients with IDA and RLS had poorer sleep quality and more emotional problems than patients with IDA without RLS. Therefore, patients with IDA should be screened for RLS to prevent adverse effects on the quality of sleep and life.

Common Factors in Biofeedback Administered by Psychotherapists.

Common factors are nonspecific therapeutic elements common across different varieties of psychotherapy. In a recent study, 68 expert psychotherapy researchers with a variety of allegiances collectively rated biofeedback as being negatively associated with many common factors (Tschacher et al. in Clin Psychol Psychother 21(1):82-96, 2014), including the therapeutic alliance. However, it seems implausible that biofeedback could benefit so many people while being incompatible with the therapeutic alliance and other common factors. The present study investigated the experiences of biofeedback clients who participated in a brief heart rate variability biofeedback protocol in order to explore the potential roles of common factors in biofeedback. The results of this study offer preliminary evidence that many common factors-including therapeutic alliance, self-efficacy expectation, mastery experiences, provision of explanatory scheme, mindfulness, and even cognitive restructuring-may play a role in biofeedback outcomes. Future research on this topic should include mediation and moderation models investigating the role of specific common factors on outcome and process studies to help determine what clinician behaviors are most helpful. Deeper investigation of common factors in biofeedback may benefit future biofeedback research and practice and address the concerns of colleagues outside of the biofeedback community who believe that biofeedback is at odds with common factors.

Parenting Stress and Child Externalizing and Internalizing Problems Among Low-Income Families: Exploring Transactional Associations.

Although the association between parenting stress and child behavioral outcomes is well established (Deater-Deckard, Clin Psychol 5:314-332, 1998), longitudinal research examining the direction of these effects is limited. This study examined transactional associations between parenting stress and child externalizing and internalizing behaviors among 1209 low-income female caregivers (Mage = 34.51) with children in early childhood or early adolescence (i.e., either 2- to 5-years-olds or 9- to 15-year-olds at Time 1) across a 6year time span using three time points. Parent-driven associations between parenting stress and child internalizing problems for the early childhood group were found. In the early adolescent group, transactional and child-driven associations were found between parenting stress and child externalizing problems, but only child-driven associations for internalizing problems. Thus, transactional associations were only supported for the early adolescent group. These findings suggest developmental differences in how parenting stress and child behavioral problems are linked among low-income families. Clinical implications are discussed.

Addiction as a Coping Response: Hyperkatifeia, Deaths of Despair, and COVID-19.

Addiction as a Coping Response: Hyperkatifeia, Deaths of Despair, and COVID-19.

Parental and Familial Predictors and Moderators of Parent Management Treatment Programs for Conduct Problems in Youth.

Despite the established efficacy of Parent Management Training (PMT) for conduct problems in youth, evidence suggests that up to half of all treated youth still display clinical levels of disruptive behavior post-treatment. The reasons for these unsatisfactory outcomes are poorly understood. The aim of the present review was to provide an updated analysis of studies from the past 15years that examined parental and familial predictors and moderators of improvement in PMT for conduct problems. A systematic literature review of indicated prevention (children with conduct problem symptoms) and intervention (children with clinical diagnoses) studies published between 2004 and 2019 was conducted. This 15-year time period was examined since the last systematic reviews were reported in 2006 and summarized studies completed through mid-2004 (see Lundahl et al. in Clin Psychol Rev 26(1):86-104, 2006; Reyno and McGrath in J Child Psychol Psychiatry 47(1):99-111, 2006). Risk of bias indices was also computed (see Higgins et al. in Revised Cochrane risk of bias tool for randomized trials (RoB 2.0), University of Bristol, Bristol, 2016) in our review. A total of 21 studies met inclusion criteria. Results indicated that a positive parent-child relationship was most strongly associated with better outcomes; however, little additional consistency in findings was evident. Future PMT research should routinely examine predictors and moderators that are both conceptually and empirically associated with treatment outcomes. This would further our understanding of factors that are associated with poorer treatment outcome and inform the development of treatment components or modes of delivery that might likely enhance evidence-based treatments and our clinical science. Protocol Registration Number: PROSPERO CRD42017058996.

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia.

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).

LGBTQ cultural competence for pharmacists

LGBTQ cultural competence for pharmacists

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

Novel Temperature Trajectory Subphenotypes in COVID-19

Novel Temperature Trajectory Subphenotypes in COVID-19

Mechanisms of Motivational Interviewing: a Conceptual Framework to Guide Practice and Research.

Reviews of the motivational interviewing (MI) training literature demonstrate MI is a nuanced skill set that takes carefully planned didactic training, application of skills in context-specific practice settings, and ongoing support to promote reflective practice and sustained proficiency. Despite the robust knowledge base related to training and how MI works to achieve favorable outcomes, these two literature bases are not well integrated. In an effort to inform and guide future research, we propose the mechanisms of motivational interviewing (MMI) conceptual framework, which expands upon previous work. Specifically, the framework adds training as an ongoing process consistent with Bennett-Levy's (Behav Cogn Psychother 34:57-78, 2006) model of skill development and acquisition to the existing two-path framework that helps us to understand how MI works to achieve its desired effects (Magill et al., J Consult Clin Psychol 82:973-983, 2014). Herein, we describe measures used to evaluate the mechanisms within the four MMI framework links: initial training to competency, competency to proficiency, proficiency to talk about change, and talk about change to behavior change. Next, we synthesize the literature associated with each of the mechanisms of the MMI. We conclude by discussing implications for practice and research. This framework offers a more complete path structure to understand the mechanisms of change associated with MI that could improve our understanding of inconsistent effect sizes observed across prior trials evaluating MI effectiveness.

When Do Posttraumatic Stress and Related Problems Abate During School-Based Group Therapy for Elementary Students?

The Bounce Back program (Langley et al. in J Consult Clin Psychol 83:853, 2015) effectively reduces post-traumatic stress (PTS) symptoms and internalizing problems among Elementary students (Langley et al. in J Consult Clin Psychol 83:853, 2015; Santiago et al. in School Psychol Q 33:1–9, 2018). Some school settings may modify the program to accommodate challenges such as logistic difficulties (e.g., a busy academic schedule) and clinicians’ discomfort with parts of the protocol (i.e., the trauma narrative). Thus, research is needed to answer the question, “Can we expect to observe change if we implement a modified Bounce Back program?” Our objectives were to (1) replicate treatment outcomes, (2) examine the timing of symptom reduction to determine whether symptoms abated before and/or after the trauma narrative, and (3) test whether baseline factors predicted incremental benefits of the trauma-narrative for PTS reduction. Twenty K-5 th grade students (47.4% Hispanic/Latino, 36.8% African-American, and 63.2% White; 68% boys) attending an urban Title I Elementary school completed the Bounce Back program and reported symptoms at pre, mid therapy (immediately before the trauma narrative), and post therapy (immediately following the program). Consistent with other trials of the Bounce Back program, students in the current sample experienced significantly reduced PTS symptoms, distress, internalizing problems, and externalizing problems. Significant change in PTS and distress occurred in the first part of treatment before the trauma narrative and did not occur during the second part of treatment. The full course of treatment was needed for significant change on secondary outcomes of internalizing and externalizing problems. Distress and bereavement assessed at baseline did not predict incremental benefits of the second half of treatment. Findings yield implementation implications and directions for future research.

Evaluating the Effects of Establishing Eye Contact on the Skill Acquisition of Individuals with Autism

Researchers widely assert that requiring eye contact from students with autism spectrum disorder (ASD) before instruction is highly important to the outcome of teaching (Greer and Ross in Verbal behavior analysis, Pearson Education, New York, 2008; Lovaas in J Consult Clin Psychol 55(1):3–9, 1977. https://doi.org/10.1037/0022-006x.55.1.3). However, to our knowledge, no research to date has evaluated the effects of this component of instruction on skill acquisition. In this current study, we evaluated the effect of requiring student eye contact from participants with ASD prior to giving an instruction on the rate of skill acquisition. Using an adapted alternating treatments design, this study compared the skill acquisition of three participants diagnosed with ASD during discrete-trial instruction (DTI) for expressive identification of novel items. Requiring eye contact was manipulated as a treatment integrity error during DTI in high-integrity, low-integrity, and control conditions. The experimenter established eye contact with the participants prior to giving an instruction during 100% of trials in the high-integrity condition, whereas eye contact was only established prior to the instruction in 67% of trials in the low-integrity condition. Results indicate that all three participants acquired expressive labels for items in fewer sessions in the high-integrity condition as compared to the low-integrity condition. Implications for the impact of eye contact on skill acquisition are discussed.

Gratitude Interventions: Effective Self-help? A Meta-analysis of the Impact on Symptoms of Depression and Anxiety

Research suggests gratitude interventions—designed to increase appreciation of positive qualities, situations, and people in one’s life—may improve psychological well-being (e.g., Seligman et al. in Am Psychol 60:410–421, 2005. https://doi.org/10.1037/0003-066X.60.5.410 ). Accordingly, mental health practitioners have promoted gratitude interventions as a means of self-help. However, results from previous reviews suggest that well-being improvements associated with gratitude interventions may be attributable to placebo effects (Davis et al. in J Couns Psychol 63:20–31, 2016. https://doi.org/10.1037/cou0000107 ; Wood et al. in Clin Psychol Rev 30:890–905, 2010, https://doi.org/10.1016/j.cpr.2010.03.005 ). With this meta-analysis, we examined the efficacy of gratitude interventions (k = 27, N = 3675) in reducing symptoms of depression and anxiety at post-test and follow-up periods. Gratitude interventions had a small effect on symptoms of depression and anxiety at both post-test (g = − 0.29, SE = 0.06, p < .01) and follow-up (g = − 0.23, SE = 0.06, p < .01). Correcting for attenuation from unreliability did not change results. Moderation analyses indicated effect sizes were larger for studies using waitlist, rather than active, control conditions at post-test and follow-up. We did not find consistent evidence for effects of other moderator variables (e.g., risk of bias, depressive symptom severity, or type of intervention used). Our results suggest the effects of gratitude interventions on symptoms of depression and anxiety are relatively modest. Therefore, we recommend individuals seeking to reduce symptoms of depression and anxiety engage in interventions with stronger evidence of efficacy for these symptoms.

Trauma and Post-traumatic Growth: Spirituality and Self-compassion as Mediators Among Parents Who Lost Their Young Children in a Protracted Conflict.

The purpose of the present study was to expand the knowledge on trauma and post-traumatic growth (PTG) by exploring this relationship in parents who lost their children in Kashmir (India). The main aim of the present study was to examine whether spirituality and self-compassion mediate the relationship between trauma and PTG. Data were collected from 80 parents in the age range of 35-80years (Mean Age = 52.09). Traumatic Grief scale Prigerson et al. (in Am J Psychiatry 154:616-623, 1997), Daily Spirituality Scale (Underwood and Teresi, Ann Behav Med 24(1):22-33, 2002), Self-Compassion Scale (Raes et al., Clin Psychol Psychoth 18:250-255, 2011), and PTG Inventory (Tedeschi and Calhoun, J Trauma Stress 9(3):455-471, 1996) scales were used to measure trauma, spirituality, self-compassion, and PTG, respectively. Results of the study indicated the presence of average amount of spirituality and high amount of trauma among the participants. High level of self-compassion and post-traumatic growth was also found among the participants. The results showed that there is no significant direct relationship between trauma and PTG; however, both the indirect paths (trauma, spirituality, and PTG as well as trauma, self-compassion, and PTG) were found to be significant. The results of the present study supported serial mediation model of Trauma and PTG through spirituality and self-compassion. It implies that trauma would lead to spirituality which in turn would lead to self-compassion and which would finally result in PTG. The result provided another lens to see the relationship between trauma and PTG.

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults: Guideline V. Assessment of Cultural Factors.

(Excerpted from "The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition." Copyright © 2016, American Psychiatric Association. Reprinted with permission.).

Toward clinically useful models for individualised prognostication in psychosis

Toward clinically useful models for individualised prognostication in psychosis

Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care: A 5- to 20-Year Follow-Up Study

Objective: Long-term follow-ups several years after receiving cognitive behavioral therapy (CBT) are scarce and most of the existing literature describes follow-up data of randomized-controlled trials. Thus, very little is known about the long-term effects of CBT in routine care. Methods: We investigated psychological functioning in a sample of 263 former outpatients who had received CBT for a variety of mental disorders such as depression, anxiety-, eating- or somatoform disorders 8.06 (SD 5.08) years after treatment termination. All participants completed a diagnostic interview as well as the Brief-Symptom Inventory (BSI) and the Beck Depression Inventory (BDI). Effect sizes and response rates according to Jacobson and Truax [J Consult Clin Psychol 1991;59:12–9] were calculated from pre- to posttreatment and from pretreatment to follow-up assessment. Results: Pre- to posttreatment effect sizes ranged between 0.75 (BDI) and 0.63 (BSI) and pretreatment to follow-up effect sizes were 0.92 (BDI) and 0.75 (BSI). Of all patients, 29% (BDI) and 17% (BSI) experienced clinically significant change at posttreatment and 42% (BDI) and 24% (BSI) at follow-up. Conclusion: The results point to the long-term effectiveness of CBT under routine conditions for a wide array of problems, especially when compared to the long-term effects of medical treatment. It is noteworthy that the results at follow-up were even better than at posttreatment, indicating further improvement. However, about a quarter of the patients did not respond sufficiently to therapy, neither concerning short-term nor long-term effects.

A virtual reality approach to mindfulness skills training

Virtual reality (VR) is increasingly incorporated into psychotherapy, with the literature documenting its effectiveness in treating anxiety disorders, pain, and stress. Few studies have incorporated VR into mindfulness interventions. The present study examined the efficacy of VR in facilitating mindfulness. It was hypothesised that a brief mindfulness intervention integrated with VR would lead to a greater elevation in mindfulness than conventional mindfulness practice. Thirty-two adults (16 males) aged 18–65 (M = 27.25, SD = 6.04) were randomly allocated to either a control condition, in which participants listened to a mindfulness audio track, or an experimental condition, in which participants received mindfulness practice in a VR beach environment. The Toronto Mindfulness Scale (Lau et al. J clin psychol 62(12):1445–1467 2006) was used to assess two mindfulness factors: curiosity and decentring. Although participants in the experimental condition experienced an increase in mindfulness, VR was not significantly more effective in facilitating mindfulness overall, although the VR condition was characterised by a significantly greater increase in decentring. Replication and investigation of causative mechanisms is necessary to further understand the distinct increase in decentring observed during VR-enhanced mindfulness training in this study.