Clare S. Rees

Meta-Analysis of Randomized, Controlled Treatment Trials for Pediatric Obsessive-Compulsive Disorder.

OBJECTIVE To conduct a meta-analysis on randomized, controlled treatment trials of pediatric obsessive-compulsive disorder (OCD). METHOD Studies were included if they employed randomized, controlled methodology and treated young people (19 years or under) with OCD. A comprehensive literature search identified 13 RCTs containing 10 pharmacotherapy to control comparisons (N = 1016) and five cognitive-behavioral therapy (CBT) to control comparisons (N = 161). RESULTS Random effects modeling yielded statistically significant pooled effect size (ES) estimates for pharmacotherapy (ES = .48, 95% CI = .36 to .61, p < .00001) and CBT (ES = 1.45, 95% CI = .68 to 2.22, p = .002). The results were robust to publication bias. CONCLUSIONS This is the first meta-analysis of treatment RCTs for pediatric OCD. CBT and pharmacotherapy were the only treatments effective beyond control in alleviating OCD symptoms. CBT showed a greater ES than pharmacotherapy. Previous meta-analyses that included uncontrolled trials exaggerated the efficacy of both treatments.

Behavioral activation interventions for well-being: A meta-analysis

One of the most promising ways to increase well-being is to engage in valued and enjoyable activities. Behavioral activation (BA), an intervention approach most commonly associated with the treatment of depression, is consistent with this recommendation and can easily be adapted for non-clinical populations. This study reports on a meta-analysis of randomized controlled studies to examine the effect of BA on well-being. Twenty studies with a total of 1353 participants were included. The pooled effect size (Hedgess g) indicated that the difference in well-being between BA and control conditions at posttest was 0.52. This significant effect, which is comparable to the pooled effect achieved by positive psychology interventions, was found for non-clinical participants and participants with elevated symptoms of depression. Behavioral activation would seem to provide a ready and attractive intervention for promoting the well-being of a range of populations in both clinical and non-clinical settings.

Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain.

&NA; The relationship between persistent pain and self‐directed, non‐reactive awareness of present‐moment experience (i.e., mindfulness) was explored in one of the dominant psychological theories of chronic pain – the fear‐avoidance model[53]. A heterogeneous sample of 104 chronic pain outpatients at a multidisciplinary pain clinic in Australia completed psychometrically sound self‐report measures of major variables in this model: Pain intensity, negative affect, pain catastrophizing, pain‐related fear, pain hypervigilance, and functional disability. Two measures of mindfulness were also used, the Mindful Attention Awareness Scale [4] and the Five‐Factor Mindfulness Questionnaire [1]. Results showed that mindfulness significantly negatively predicts each of these variables, accounting for 17–41% of their variance. Hierarchical multiple regression analysis showed that mindfulness uniquely predicts pain catastrophizing when other variables are controlled, and moderates the relationship between pain intensity and pain catastrophizing. This is the first clear evidence substantiating the strong link between mindfulness and pain catastrophizing, and suggests mindfulness might be added to the fear‐avoidance model. Implications for the clinical use of mindfulness in screening and intervention are discussed.

Mindfulness-based Cognitive Therapy for Generalized Anxiety Disorder: A Preliminary Evaluation

Mindfulness training has been proposed as a potentially important new approach for the treatment of generalized anxiety disorder (GAD). However, to date only a few studies have investigated mindfulness training for GAD. The aim of this study was to further investigate symptom change and recovery in pathological worry after mindfulness-based cognitive therapy (MBCT) using an uncontrolled pre-post design. Twenty-three adults with a primary diagnosis of GAD participated in the study. The MBCT program involved 9 weekly 2-hour group sessions, a post-treatment assessment session, and 6-week and 3-month follow-up sessions. Intent-to-treat analysis revealed significant improvements in pathological worry, stress, quality of life, and a number of other symptoms at post-treatment, which were maintained at follow-up. Attrition was also low, and MBCT was perceived as a credible and acceptable intervention. However, when applying standardized recovery criteria to pathological worry scores, the rate of recovery at post-treatment was very small, although improved at follow-up. Overall, the findings suggest MBCT is definitely worthy of further investigation as a treatment option for GAD, but falls well short of outcomes achieved by past research. Possible reasons for the poor rate of recovery, implications, and limitations are briefly outlined.

Therapeutic alliance in face-to-face versus videoconferenced psychotherapy

Despite the great potential videoconferencing holds for providing psychotherapy services to a wide range of individuals, it is presently underused by psychologists. Do psychologists hold negative attitudes that interfere with their willingness to use the technology? What do psychologists think about the impact of the technology on the therapeutic alliance? Thirty clinical psychologists were randomly assigned to watch an identical therapy session, either face-to-face or videoconferencing format. Our prediction that psychologists in the videoconferencing condition would rate the therapeutic alliance significantly lower than would psychologists in the face-to-face condition was supported. We discuss the need to develop appropriate therapist training and improve the general dissemination of information regarding videoconferencing as an important means by which to reduce negative attitudes toward the technology.

Can We Predict Burnout among Student Nurses? An Exploration of the ICWR-1 Model of Individual Psychological Resilience.

The nature of nursing work is demanding and can be stressful. Previous studies have shown a high rate of burnout among employed nurses. Recently, efforts have been made to understand the role of resilience in determining the psychological adjustment of employed nurses. A theoretical model of resilience was proposed recently that includes several constructs identified in the literature related to resilience and to psychological functioning. As nursing students are the future of the nursing workforce it is important to advance our understanding of the determinants of resilience in this population. Student nurses who had completed their final practicum were invited to participate in an online survey measuring the key constructs of the ICWR-1 model. 422 students from across Australia and Canada completed the survey between July 2014 and July 2015. As well as several key demographics, trait negative affect, mindfulness, self-efficacy, coping, resilience, and burnout were measured. We used structural equation modeling and found support for the major pathways of the model; namely that resilience had a significant influence on the relationship between mindfulness, self-efficacy and coping, and psychological adjustment (burnout scores). Furthermore, as predicted, Neuroticism moderated the relationship between coping and burnout. Results are discussed in terms of potential approaches to supporting nursing students who may be at risk of burnout.

Relationship Between Homework Completion and Outcome in Cognitive Behaviour Therapy

Homework or between‐session learning has long been considered an essential aspect of effective cognitive behaviour therapy. However, it has received relatively less empirical attention than other components of cognitive behaviour therapy. In general, studies have found that homework completion is predictive of outcome in psychotherapy. However, the amount of homework completed by a patient represents only one aspect of this important therapeutic component. This study investigated both the quantity and the quality of homework completed during a 10‐week group cognitive and behavioural treatment program for anxious and depressed patients. It explored the relationship between various aspects of homework completion and outcomes on several different variables. A total of 94 patients were included in the analysis. It was found that both quantity and quality of homework completed predicted outcome on measures of depression, anxiety and quality of life at post‐treatment and at 1‐month follow‐up. The results were strongest for the amount of homework completed, suggesting that clinicians should encourage patients to complete homework even if the homework content is not entirely accurate. The results of this study highlight the importance of homework as a central part of effective cognitive and behavioural treatment.

Medical utilisation and costs in panic disorder : A comparison with social phobia

There is considerable evidence that people with panic disorder utilise the physical health care system more frequently than people in the general community and so incur for themselves, and impose on the public health care system, considerably greater costs. Although this is probably because of specific characteristics to do with panic disorder, it may also be a function of having any anxiety disorder where panic is prominent. This study represents one of the few comparisons of medical utilisation and costs incurred by people with panic disorder to those incurred by people with another anxiety disorder, in this case, social phobia. Before treatment, 41 people with panic disorder, 15 with social phobia and 43 nonanxious controls were interviewed about their use of the medical care system over the previous 12 months. As expected, people with panic disorder had significantly higher utilisation rates than either the nonanxious controls or the socially phobic subjects, and incurred substantially higher costs. Adequate screening for panic disorder at the primary medical care level together with appropriate treatment referral therefore have the potential to substantially reduce the personal and community costs incurred by people with panic disorder.

Understanding individual resilience in the workplace: The international collaboration of workforce resilience model

When not managed effectively, high levels of workplace stress can lead to several negative personal and performance outcomes. Some professional groups work in highly stressful settings and are therefore particularly at risk of conditions such as anxiety, depression, secondary traumatic stress, and burnout. However, some individuals are less affected by workplace stress and the associated negative outcomes. Such individuals have been described as “resilient.” A number of studies have found relationships between levels of individual resilience and specific negative outcomes such as burnout and compassion fatigue. However, because psychological resilience is a multi-dimensional construct it is necessary to more clearly delineate it from other related and overlapping constructs. The creation of a testable theoretical model of individual workforce resilience, which includes both stable traits (e.g., neuroticism) as well as more malleable intrapersonal factors (e.g., coping style), enables information to be derived that can eventually inform interventions aimed at enhancing individual resilience in the workplace. The purpose of this paper is to introduce a new theoretical model of individual workforce resilience that includes several intrapersonal constructs known to be central in the appraisal of and response to stressors and that also overlap with the construct of psychological resilience. We propose a model in which psychological resilience is hypothesized to mediate the relationship between neuroticism, mindfulness, self-efficacy, coping, and psychological adjustment.

Telepsychology and videoconferencing: Issues, opportunities and guidelines for psychologists

Telehealth has been around for a long time. Currently, its application is dominated by mental health and predominantly by the discipline of psychiatry. Telepsychology refers to the use of technology-assisted means to provide psychological services. One such technological approach, videoconferencing, enables the provision of psychological services via a live, interactive two-way video – audio system. Videoconferencing is used extensively in Australia but the discipline of psychology is yet to fully embrace the technology. A possible explanation for this is the lack of information and discussion specific to the discipline of psychology as to the effectiveness of the technology and issues relating to its use for provision of psychological services. This paper attempts to provide such information relevant to psychologists as well as a discussion of some of the practical considerations in its use. Specifically, practical guidelines are offered that relate to provision of education and training via videoconfere...