Clinical Psychological Science Research Articles

Psychological clinical science: Meeting the challenge of public mental health

The purpose of this article is to provide a brief overview of how clinical psychology evolved in the United States as a prelude to discussing the emergence of psychological clinical science in the closing years of the 20th century. Despite the growth of clinical psychology, mental disorders remain highly prevalent, compelling us to envision new ways to deliver services in an effective but efficient manner. Topics include the dissemination gap, the affordable access gap, and the Psychological Clinical Science Accreditation System (PCSAS). Examples of novel methods for addressing the problem of public mental health in the 21st century are discussed. Finally, I close by considering the potential relevance of our experience in America for European clinical psychology.

Generalized anxiety disorder and selective attention: An unsuccessful replication of Yiend et al., (2015) in a student population

ABSTRACT Generalized Anxiety Disorder (GAD) is an anxiety disorder that is believed to affect attention (Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059–2068. https://doi.org/10.1056/NEJMcp1502514; Yiend, J., Mathews, A., Burns, T., Dutton, K., Fernández-Martín, A., Georgiou, G. A., Luckie, M., Rose, A., Russo, R., & Fox, E. (2015). Mechanisms of selective attention in generalized anxiety disorder. Clinical Psychological Science, 3(5), 758–771. https://doi.org/10.1177/2167702614545216). Previous literature has found that selective attention is changed when someone perceives threatening stimuli, such as an angry face, and that those with anxiety disorders, may have a heightened or delayed response to threatening stimuli (Richards, H. J., Benson, V., Donnelly, N., & Hadwin, J. A. (2014). Exploring the function of selective attention and hypervigilance for threat in anxiety. Clinical Psychology Review, 34(1), 1–13. https://doi.org/10.1016/j.cpr.2013.10.006; Stevens, C., & Bavelier, D. (2012). The role of selective attention on academic foundations: A cognitive neuroscience perspective. Developmental Cognitive Neuroscience, 2, S30–S48. https://doi.org/10.1016/j.dcn.2011.11.001), which may alter how fast a presented task is completed (Yiend et al., 2015). The present study aimed to reproduce findings by Yiend et al. (2015), which identified an unexpected pattern in those with GAD: faster disengagement from angry faces compared to positive (happy, neutral) faces. The present study recruited a larger (nonclinical) sample from a student population to achieve greater statistical power. None of the findings reported by Yiend and colleagues (Experiment 1; 2015) were replicated in a student sample. The implications are discussed.

Response to responsible research assessment I and II from the perspective of the DGPs working group on open science in clinical psychology

We comment on the papers by Schönbrodt et al. (2022) and Gärtner et al. (2022) on responsible research assessment from the perspective of clinical psychology and psychotherapy research. Schönbrodt et al. (2022) propose four principles to guide hiring and promotion in psychology: (1) In addition to publications in scientific journals, data sets and the development of research software should be considered. (2) Quantitative metrics can be useful, but they should be valid and applied responsibly. (3) Methodological rigor, research impact, and work quantity should be considered as three separate dimensions for evaluating research contributions. (4) The quality of work should be prioritized over the number of citations or the quantity of research output. From the perspective of clinical psychology, we endorse the initiative to update current practice by establishing a matrix for comprehensive, transparent and fair evaluation criteria. In the following, we will both comment on and complement these criteria from a clinical-psychological perspective.

Understanding Ethnoracial Disparities and Advancing Mental Health Equity Through Clinical Psychological Science: Introduction to Special Issue

Mental health disparities persist in countries such as the United States and across the world. Research with disparity populations is underrepresented in mainstream clinical psychological journals, and existing science has not focused on group specific lived experiences. Achieving mental health equity requires examination of determinants of psychopathology and health disparities and personal and cultural attributes that promote mental health. Clinical psychological science ideally also encourages and values research with underrepresented minority and underserved populations, novel and underused study designs, and research produced by diverse scholars. Our special issue highlights research that considers systematically culture specific processes, examines not only individual- but also community-level factors that relate to psychopathology and mental-health care, and challenges structural limitations in the current literature. We review these articles that incorporate innovative and community engaged approaches and showcase the importance of diversity in researcher and research participant demographics and perspectives in the advancement of equity in clinical psychological science.

Toward a Science of Clinical Psychology: A Tribute to the Life and Works of Scott O. Lilienfeld

Toward a Science of Clinical Psychology: A Tribute to the Life and Works of Scott O. Lilienfeld

From Allies of “Conversion Therapy” to Accomplices of Justice: Invited Concluding Comment to the C&BP Special Series

This special feature of Cognitive and Behavioral Practice serves to remind psychological scientists and other mental health clinicians of the importance of understanding our responsibilities in the field with specific reference to sexual orientation and gender identity “conversion therapy” efforts: from considering our ethical responsibilities in our practice (Davison) to understanding the widespread iatrogenic impacts of “conversion therapy” practice in all its subtleties (Anderson et al.), from staying abreast of the contemporary anti-LGBTQ+ talking points (Haldeman) to understanding how this rhetoric targets specific subpopulations in the U.S. currently (Hope & Puckett). We conclude this special series by reminding the reader that structures within our institutions and day-to-day functioning uphold and foster an unethical and iatrogenic practice. We point out the need to be alert. Clinical psychological science is not value-free. Pretending that it is serves the obfuscation of scientific findings and equips scholars who hold vested interests in seeing the dangerous practice of “conversion therapy” legitimized and disseminated in a larger scale.

Transparency and the Mindfulness Opacity Hypothesis

Abstract Many philosophers endorse the Transparency Thesis, the claim that by introspection one cannot become aware of one's experience. Recently, some authors have suggested that the Transparency Thesis is challenged by introspective states reached under mindfulness. We label this the Mindfulness Opacity Hypothesis. The present paper develops the hypothesis in important new ways. First, we motivate the hypothesis by drawing on recent clinical psychology and cognitive science of mindfulness. Secondly, we develop the hypothesis by describing the implied shift in experiential perspective, the scope of introspectable qualities, and the level of skill. Thirdly, we defend the hypothesis against various philosophical arguments. We conclude that the Mindfulness Opacity Hypothesis is empirically and theoretically well motivated and supported.

Challenges and ways forward in bridging units of analysis in clinical psychological science.

For decades, experiential measures (i.e., self- and informant-report) have dominated clinical psychological science as the primary methods of investigating the nature, causes, and consequences of psychopathology. Recent efforts to understand psychopathology in a comprehensive manner, bridging across measurement modalities and study designs, have yielded disappointing results and small cross-domain effect sizes. This problem has stymied progress in diagnosing and treating mental illness. We contend that we continue to struggle to link different units of analysis in psychopathology research because, as a field, we have not learned the lessons that have been detailed in the literature since at least the 1950s. We argue that our reliance on single units of analysis (e.g., only self-report or only neuroimaging) to conceptualize and operationalize psychological constructs lies at the heart of our struggles. Conflation of a construct with its operationalization in a single measurement modality fundamentally limits the ability to understand its manifestation in other units of analysis. To make progress toward a fine-grained understanding of the symptoms, signs, and mechanisms of psychopathology, we must move past the siloed reification of constructs and prioritize new, integrated research paradigms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

'Visible' compulsions: OCD and the politics of science in British clinical psychology, 1948-1975.

This article historicizes a single stage in how the contemporary obsessive-compulsive disorder (OCD) category was built. Starting from the position that the two central components which make up OCD are 'obsessions' and 'compulsions', it illustrates how these concepts were taken apart by a small group of clinical psychologists working at the Institute of Psychiatry and the Maudsley psychiatric hospital in south London in the early 1970s, and why compulsions were investigated whilst obsessions were ignored. The decision to distinguish the previously undifferentiated symptoms is attributed to the commitment amongst psychologists at the Maudsley, most notably Stanley Rachman, to an empirical conception of science which emphasized observability. Two aspects of this are discussed. First, compulsions were deemed 'visible' through their correspondence with animal behaviour. Second, the symptom was seen as open to an experimental modification procedure which privileged visible outcomes. Ultimately, the article concludes that the historical division between 'obsessions' and 'compulsions', and the extensive investigation of the latter, has had substantial implications for the development of OCD as a category centred on visible behaviours and treated through behavioural means.

Current Issues and Future Directions in Clinical Psychological Science: An Introduction to the Special Issue Honoring the Life and Legacy of Scott O. Lilienfeld

This special issue is dedicated to the life and works of psychology pioneer Scott O. Lilienfeld. Dr. Lilienfeld tragically passed away in September 2020 and was one of the field’s most brilliant minds and prolific contributors. As a leading authority on psychopathy and the delineation between science and pseudoscience and a prodigious scholar across multiple areas of inquiry, Dr. Lilienfeld’s contributions have transformed psychological science in myriad ways. We bring together eminent scholars from across the world to contribute target articles on cutting-edge advancements and ongoing issues that encompass rhetoric in science, structural models of psychopathology, experimental psychopathology research, sociopolitical values in the multicultural movement, positive illusions about societal change, procedural justice in psychology, the so-called Memory Wars, and lifelong learning.

Reforming clinical psychological science training: The importance of collaborative decision-making with trainees.

To effectively address the staggering burden of mental illness, clinical psychological science will need to face some uncomfortable truths about current training practices. In a commentary authored by 23 current or recent trainees, Palitsky and colleagues highlight a number of urgent challenges facing today's clinical interns. They provide a thoughtful framework for reform, with specific recommendations and guiding questions for a broad spectrum of stakeholders. Key suggestions are applicable to the entire sequence of clinical training. While there is cause for cautious optimism, overcoming these systemic barriers will require a coordinated, all-hands approach and a more collaborative approach to policy-making.

Students’ interaction anxiety and social phobia in interprofessional education in Hong Kong: mapping a new research direction

Background Interprofessional education (IPE) has been promoted as a breakthrough in healthcare because of the impact when professionals work as a team. However, despite its inception dating back to the 1960s, its science has taken a long time to advance. There is a need to theorize IPE to cultivate creative insights for a nuanced understanding of IPE. This study aims to propose a research agenda on social interaction by understanding the measurement scales used and guiding researchers to contribute to the discussion of social processes in IPE. Method This quantitative research was undertaken in a cross-institutional IPE involving 925 healthcare students (Medicine, Nursing, Social Work, Chinese Medicine, Pharmacy, Speech Language Pathology, Clinical Psychology, Food and Nutritional Science and Physiotherapy) from two institutions in Hong Kong. Participants completed the Social Interaction Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6). We applied a construct validation approach: within-network and between-network validation. We performed confirmatory factors analysis, t-test, analysis of variance and regression analysis. Results CFA results indicated that current data fit the a priori model providing support to within-network validity [RMSEA=.08, NFI=.959, CFI=.965, IFI=.965, TLI=.955]. The criteria for acceptable fit were met. The scales were invariant between genders, across year levels and disciplines. Results indicated that social interaction anxiety and social phobia negatively predicted behavioural engagement (F = 25.093, p<.001, R 2=.065) and positively predicted behavioural disaffection (F = 22.169, p<.001, R 2=.057) to IPE, suggesting between-network validity. Conclusions Our data provided support for the validity of the scales when used among healthcare students in Hong Kong. SIAS-6 and SPS-6 have sound psychometric properties based on students’ data in Hong Kong. We identified quantitative, qualitative and mixed methods research designs to guide researchers in getting involved in the discussion of students’ social interactions in IPE. Key Messages The Social Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6) scales have sound psychometric properties based on the large-scale healthcare students’ data in IPE in Hong Kong. Social interaction anxiety and social phobia negatively predicted students’ behavioural engagement with IPE and positively predicted behavioural disaffection. The scales are invariant in terms of gender, year level and discipline. Quantitative, qualitative and mixed methods studies are proposed to aid researchers to contribute in healthcare education literature using the SIAS-6 and SPS-6.

Opportunities to improve student mathematics achievement and outcomes: Building student–teacher relationships and the integration of inclusive and equity‐minded teaching practices

Opportunities to improve student mathematics achievement and outcomes: Building student–teacher relationships and the integration of inclusive and equity‐minded teaching practices

Promoting Resilience in Dementia Caregivers: Roybal Centers for Translational Research on Dementia Care Provider Support

Providing care for family members with Alzheimer's disease or related dementias (ADRD) is an increasingly common experience for older adults and can present both challenges to mental health and opportunities for resilience and growth. Compared to non-caregivers, dementia caregivers greater stress and depressive and anxiety symptoms, greater social disconnection (isolation, low social support, loneliness), faster aging-related cognitive decline, and worse physical health (National Academies of Sciences, 2021). However, some caregivers report positive aspects of the caregiving experience, including enhanced purpose in life. Numerous studies document benefits of behavioral interventions for caregiving stress for individuals with dementia and caregivers. However, these interventions are not routinely offered, and no single intervention stands out as clearly evidence based. One limiting factor is a lack of understanding of the mechanisms whereby interventions work that could be used to ensure interventions are delivered outside research contexts in ways that retain essential ingredients, allow adaption to diverse populations, and can be flexibly delivered given limited resources. The National Institute on Aging funds four Roybal Centers for Translational Research on Dementia Care Provider Support and tasks these Centers with conducting mechanism-focused clinical trials to improve caregiver outcomes, in line with the NIH Stage Model of Intervention Development (Onken et al., 2014). This panel will address the conference theme of resilience and diversity in aging by describing the work of two Roybal Centers, one focused on social connectedness and another on caregiving mastery, including engagement with diverse caregiver populations. Dr. Van Orden is a Co-Director of the Rochester Roybal Center for Social Ties & Aging Research and will begin the session with a brief overview of the Rochester and Emory Roybal Centers, including the pilot award programs. Next, investigators will present their work to illustrate research being done by the Centers and highlight areas for potential synergies. First, Dr. Emily Bower, a Co-investigator at the Rochester Roybal Center, will present findings from a pilot study on Engage Coaching for Caregivers, a brief coaching program to reduce loneliness in ADRD caregivers. Dr. Quiñones-Cordero will describe ongoing collaborative efforts between the Rochester and Emory Centers to culturally adapt a skills-based and mastery building intervention for Hispanic caregivers.Onken, L. S., Carroll, K. M., Shoham, V., Cuthbert, B. N., & Riddle, M. (2014). Reenvisioning Clinical Science: Unifying the Discipline to Improve the Public Health. Clinical Psychological Science, 2, 22-34. National Academies of Sciences, E., and Medicine, (2021). Meeting the Challenge of Caring for Persons Living with Dementia and Their Care Partners and Caregivers: A Way Forward. T. N. A. Press.

Rhetoric and Clinical Science: Maximizing Rationality Within Post-Justificationist Knowledge

Scott Lilienfeld wrote about science and metascience and cared deeply about clearly understanding the quality of science. Lilienfeld criticized obscurantist language such as “neurobabble” and poorly defined terms such as “microaggressions.” Science is a social institution that involves communication through language. This article presents a rhetorical analysis of science. The study of the linguistic dimension of science leads to an analysis of science as rhetoric, that is, the multiple methods of persuasion employed by scientists for multiple audiences and consumers. In addition, the failure of justificationist epistemologies to capture what occurs in knowledge generation also leads to the view that science has a rhetorical dimension in which knowledge-generating processes remain rational but nonjustificationist. In this article, I argue that rhetoric provides a rich additional dimension for criticism in clinical psychological science to identify error. Engaging the rhetorical dimension of science can therefore make science more rational, not less. Some major tropes used in psychological journals are identified and criticized.

Stigmatizing Our Own: Self-Relevant Research (Me-Search) Is Common but Frowned Upon in Clinical Psychological Science

How often do clinical psychologists have a lived experience with, or close connection, to their research? Does the field of psychology accept this “me-search”? We undertook the first investigation of self-relevant research (aka “me-search”) and attitudes toward self-relevant researchers in a representative North American sample ( N = 1,776) of faculty, graduate students, and other individuals affiliated with doctoral programs in clinical, counseling, and school psychology. More than 50% of participants had conducted self-relevant research, and those from minoritized backgrounds were more likely to conduct self-relevant research. When judging experimentally manipulated vignettes, participants who had not engaged in self-relevant research made more stigmatizing judgments of self-relevant research and self-relevant research disclosure than did those who engaged in self-relevant research. Psychologists and trainees had more negative attitudes toward self-relevant research on mental health topics (suicide, depression, schizophrenia) than physical health topics (cancer). We discuss how prejudice toward self-relevant research and mental illness negatively impacts ongoing diversity and inclusion efforts from within clinical psychological science.

Clinical psychological science must move beyond documenting disparities in LGBTQ health toward eliminating them.

Psychology and other disciplines have exceptionally documented sexual orientation and gender identity disparities in mental and physical health outcomes with psychological antecedents. Research on sexual and gender minority (SGM) health has seen impressive growth, including the launch of dedicated conferences, journals, and designation as a disparity population for U.S. federal research purposes. From 2015 to 2020, the number of SGM-focused research projects funded by the U.S. National Institutes of Health (NIH) increased by 66.1% (cf. 21.8% for all NIH projects). SGM health research has expanded beyond HIV (73.0% of NIH's SGM projects in 2015 down to 59.8% in 2020) into other domains, such as mental health (41.6%), substance use disorders (23%), violence (7.2%), and transgender (21.9%) and bisexual (17.2%) health. Yet, only 8.9% of projects were clinical trials testing interventions. The need for more research on later stages in the translational research spectrum (i.e., mechanisms, intervention, implementation) to eradicate SGM health disparities is the focus of our Viewpoint article. First, research to eliminate SGM health disparities must move toward multilevel interventions aimed at cultivating health, wellbeing, and thriving. Second, research to test how psychological theories apply to SGM people can inform new theories or extend existing ones, which can spur new areas of inquiry. Third, translational SGM health research would benefit from a developmental lens to identify protective and promotive factors across the life span. Finally, using mechanistic findings to inform, develop, disseminate, and implement interventions to reduce SGM health disparities is crucial at this time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Personality disorders research and social decontextualization: What it means to be a minoritized human.

Models of personality disorders have overwhelmingly developed in a socially decontextualized manner. Some historical models of personality pathology formally embraced the interactions between the individual and their environment. However, the field of personality disorder theory, research, and treatment has evolved in a manner that situates dysfunction within intraindividual deficiency processes. By doing so the field limits its applicability to populations that do not represent the norm in clinical psychological science (e.g., sexual/gender minority [SGM] persons for our purposes). Assumptions about personality disorders conflict with evidence-based ways of understanding psychosocial dysfunction among minoritized populations. Using research on SGM populations, and the detrimental impact of minority stress, we demonstrate how sociocultural context is inextricably linked to psychosocial functioning, which remains at odds with personality disorder theory and research. We first briefly review the historical roots of personality disorder theory; explore how sociocultural context is currently instantiated in official nosologies as the Diagnostic and Statistical Manual of Mental Disorders and the Psychodynamic Diagnostic Manual; and illustrate how intraindividual personality disorder conceptualization fails to align with the accepted understanding of how minority stress impacts the health of SGM populations. Finally, we end with a few recommendations for (a) future research on personality disorders and (b) clinical work with SGM individuals who might demonstrate behaviors typically associated with a personality disorder diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Editorial.

The Journal of Consulting and Clinical Psychology (JCCP) has been one of the core scientific journals in clinical psychology for decades, with high-quality, innovative, and cutting-edge research that has shaped the science and practice of the field as it currently stands. It is a great honor to have been selected as the new Editor of JCCP for the next 5 years, starting with this issue. As the new editor, I will first build on the excellent work previous editors have done in making JCCP what it is now, a vehicle for innovation and improvement in the science and practice of clinical psychology. I am proud to lead an excellent team of highly qualified associate and consulting editors (CEs) to preserve and to further strengthen the journal's position. However, innovation also means change and establishing new opportunities that have the potential to further science and practice. In the following, I will describe some ideas and views that will guide the content, structure, and format of JCCP in the coming years. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reflections on the Personality and Psychopathology Interface in Honor of Scott O. Lilienfeld: Toward Illuminating the Nature of the Processes Underlying Personality Disturbances

Scott O. Lilienfeld maintained an intense and probing interest in the interface of personality and psychopathology. He was especially intrigued by the personality systems subserving the clinical construct/disorder of psychopathy. Each of us knew Lilienfeld at various junctures in his academic career, and here we celebrate his scientific interest in this substantive area of clinical psychological science. We share our intellectual and theoretical forays in the challenging terrain of the personality–psychopathology interface through brief overviews of our respective contributions and models on this topic. We share our perspectives, which at times are overlapping and at times divergent, with reference to the corpus of published work that each of us has produced through our respective research programs. We invite the reader to sample our different perspectives, to engage with this fascinating area, and, in doing so, to implicitly embrace Lilienfeld’s scientific passion for this developing area of personality and psychopathology science.