Analise O'Donovan

A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events

BACKGROUND Childbirth has been linked to postpartum impairment. However, controversy exists regarding the onset and prevalence of post-traumatic stress disorder (PTSD) after childbirth, with seminal studies being limited by methodological issues. This longitudinal prospective study examined the prevalence of PTSD following childbirth in a large sample while controlling for pre-existing PTSD and affective symptomatology. METHOD Pregnant women in their third trimester were recruited over a 12-month period and interviewed to identify PTSD and anxiety and depressive symptoms during the last trimester of pregnancy, 4-6 weeks postpartum, 12 weeks postpartum and 24 weeks postpartum. RESULTS Of the 1067 women approached, 933 were recruited into the study. In total, 866 (93%) were retained to 4-6 weeks, 826 (89%) were retained to 12 weeks and 776 (83%) were retained to 24 weeks. Results indicated that, uncontrolled, 3.6% of women met PTSD criteria at 4-6 weeks postpartum, 6.3% at 12 weeks postpartum and 5.8% at 24 weeks postpartum. When controlling for PTSD and partial PTSD due to previous traumatic events as well as clinically significant anxiety and depression during pregnancy, PTSD rates were less at 1.2% at 4-6 weeks, 3.1% at 12 weeks and 3.1% at 24 weeks postpartum. CONCLUSIONS This is the first study to demonstrate the occurrence of full criteria PTSD resulting from childbirth after controlling for pre-existing PTSD and partial PTSD and clinically significant depression and anxiety in pregnancy. The findings indicate that PTSD can result from a traumatic birth experience, though this is not the normative response.

The dose response relationship in psychotherapy: Implications for social policy

The principle aim of this study was to estimate the number of sessions of psychotherapy needed for clients suffering from psychiatric illness to return to a normal state of functioning or reliably improve. This would be helpful for treatment planning and policy decisions regarding how much therapy is enough. The progress of 125 clients entering psychological treatment in two university training clinics was tracked on a session-by-session basis using a naturalistic design. Recovery and reliable improvement were the bi-nomial events of interest used in a survival analysis that estimated the number of weekly treatment sessions needed to meet criteria. Using survival analysis it was estimated that it would take about 8 sessions for 50% of clients to show reliable improvement and 21 sessions for about 85% to meet this criterion. Recovery took more treatment, with 50% of clients estimated to recover after 14 sessions and 70% requiring 23. On the basis of the present results we conclude that the present policy of the Australian Government in both the public and private sector regarding the number of sessions needed for clients entering psychological treatments to show a benefit is much less than is, in fact, necessary. The findings of the current study are roughly consistent with those found elsewhere and suggest a minimum benefit should be closer to 20 sessions. The current policy appears to be suitable for only about one-third of clients who carry the burden of psychological illness.

The positive effects of mindfulness on self-esteem

Positive psychological research has clearly highlighted the importance of investigating factors that contribute to well-being. One factor contributing greatly to psychological well-being is mindfulness, which has been related to a wide range of positive outcomes, including healthy self-esteem. Here, we present two studies that aim to extend prior research on mindfulness and self-esteem. In Study 1, we propose and test a theoretically derived model of the role that mindfulness plays in the prediction of self-esteem and life satisfaction. Four facets of mindfulness significantly predicted increased self-esteem, which in turn predicted overall life satisfaction. In Study 2, we extended this study by examining the direct effects of a brief mindfulness induction on state self-esteem, and found that experimentally enhancing state mindfulness led to an increase in state self-esteem. The two studies presented clearly demonstrate that mindfulness and self-esteem are related, and, importantly, that mindfulness training has direct positive effects on self-esteem.

Independence of Hot and Cold Executive Function Deficits in High-Functioning Adults with Autism Spectrum Disorder

Individuals with autistic spectrum disorder (ASD) display diverse deficits in social, cognitive and behavioral functioning. To date, there has been mixed findings on the profile of executive function deficits for high-functioning adults (IQ > 70) with ASD. A conceptual distinction is commonly made between “cold” and “hot” executive functions. Cold executive functions refer to mechanistic higher-order cognitive operations (e.g., working memory), whereas hot executive functions entail cognitive abilities supported by emotional awareness and social perception (e.g., social cognition). This study aimed to determine the independence of deficits in hot and cold executive functions for high-functioning adults with ASD. Forty-two adults with ASD (64% male, aged 18–66 years) and 40 age and gender matched controls were administered The Awareness of Social Inference Test (TASIT; emotion recognition and social inference), Letter Number Sequencing (working memory) and Hayling Sentence Completion Test (response initiation and suppression). Between-group analyses identified that the ASD group performed significantly worse than matched controls on all measures of cold and hot executive functions (d = 0.54 − 1.5). Hierarchical multiple regression analyses revealed that the ASD sample performed more poorly on emotion recognition and social inference tasks than matched controls after controlling for cold executive functions and employment status. The findings also indicated that the ability to recognize emotions and make social inferences was supported by working memory and response initiation and suppression processes. Overall, this study supports the distinction between hot and cold executive function impairments for adults with ASD. Moreover, it advances understanding of higher-order impairments underlying social interaction difficulties for this population which, in turn, may assist with diagnosis and inform intervention programs.

Effective training in clinical and counselling psychology: Not as simple as it sounds

In this article, we introduce this special issue on training in clinical and counselling psychology by identifying issues that confront educators in particular, but the profession more generally. Issues include whether training courses are effective, whether universities are where training should occur, which students should be accepted for training, and when ought training to occur.

Australian clinical psychology training program directors survey

A survey of clinical psychology program directors was conducted to provide an illustrative snapshot of clinical training in Australia. Postgraduate clinical psychology program directors from 27 universities in all States in Australia and the Australian Capital Territory offering postgraduate clinical training programs were emailed the survey; 19 surveys were returned. The present paper reports on a range of issues of relevance to clinical training programs, including numbers of students, types and content of courses, staff workload, relationship with professional bodies, practical training and university-based clinics, and concerns raised by directors. The information is intended to assist those responsible for training in clinical psychology in Australia in their work of increasing the quality of postgraduate training by being informed of the practices of other programs.

Evaluating training effectiveness in psychotherapy: lessons for the AOD field.

Based on evaluations of effectiveness training on trainee and client outcome in the psychotherapy field, this paper presents a model and recommendations for the alcohol and other drug (AOD) field to consider when conducting investigations into training. Determining the effectiveness of training requires the consideration of a number of factors, including pre-existing trainee variables, methods of training and ability of trainers and the focus of training. The influence of each of these factors may be considered first in terms of proximal outcomes such as trainee satisfaction, improvements in clinical practice and knowledge, and secondly in terms of more distal outcomes, such as the impact that training may have on improving client outcome. The current literature regarding these factors pertaining to psychotherapy outcome is reviewed, and recommendations for evaluating training in the AOD field are made.

Does a clinical psychology education moderate relationships between personality or emotional adjustment and performance as a clinical psychologist

Does an education in clinical psychology affect relationships between personality or emotional adjustment and clinical knowledge or clinical practice ability? Two groups were assessed at the beginning of their professional development and 1 year later. The 1st group was studying clinical psychology, and the 2nd group was obtaining training under a workplace supervision model. At pretest, measures of defensiveness were correlated with practice ability, and participants who had emotional adjustment problems obtained lower practice ability scores. At posttest, neither pretest personality nor emotional adjustment was correlated with clinical performance. An interaction between education group and problem group suggests that a clinical education enhances the performance of students with emotional problems at the onset of their education

What are the Benefits of Longer Training in Psychology? A Comment on Helmes and Wilmoth (2002)

Helmes and Wilmoth (2002) assert that the Australian model of educating psychologists is inadequate. They advocate adoption of the North American model. Their advocacy ignores the fact that the effectiveness of advanced professional training in psychology has not been demonstrated, and the fact that psychology practitioners from all parts of the world value supervised work with clients above formal courses as a positive influence on professional development. If we wish to increase the competence and effectiveness of psychologists, it is more appropriate that we restructure our entry-level education so that it emphasises real-world problem solving and hands-on work with clients than that we increase the duration of entry-level education.

Opinions of Australian Psychological Society College Chairs about process and content in supervision training: Preliminary investigation in Queensland

Few psychologists in Australia have been trained to provide supervision to probationary psychologists. The current preliminary study investigated whether a supervision training workshop could, in the view of representative psychologists, provide effective training across a range of psychological specialties, or whether separate training was needed for different specialties. The nine Queensland Chairs of the Australian Psychological Society specialisation colleges were given a semistructured interview to investigate the goals, content and processes of supervision within their specialty, and perceived relationships with other specialties. Results indicated considerable agreement regarding the content and process of supervision across specialties, suggesting that supervision has much in common regardless of specialty.