Shane T. Harvey

Updating a Meta-Analysis of Intervention Research with Challenging Behaviour: Treatment Validity and Standards of Practice.

Abstract Background This meta-analysis of interventions with challenging behaviour in children with disabilities updates a comprehensive meta-analysis that previously addressed reported standards of practice and effectiveness of different strategies. Method Four effect-size algorithms were calculated for published intervention cases, and results analysed and compared to previous findings by behaviour target, intervention type, and other factors. Results The evidence largely supports intervention effectiveness, with some inconsistency reflecting the fact that the four metrics assess different aspects of change. Skills replacement, consequence combined with systems change, and antecedent interventions generated selective positive results, large enough to be clinically meaningful. Conclusions Behavioural interventions effectively reduce challenging behaviour, particularly when preceded by a functional analysis. Teaching replacement skills was most effective, especially if used in combination with systems change and/or traditional antecedent and consequence manipulation. Positive changes as well as enduring limitations to both research design and standards of clinical practice in comparison to 18 years ago are discussed.

A meta-analysis of the effects of psychotherapy with sexually abused children and adolescents

This paper presents a meta-analysis of the psychotherapy treatment outcome studies for sexually abused children and adolescents. There were 39 studies included, most of which aimed to treat the psychological effects of childhood sexual abuse. Separate meta-analyses were conducted according to study design and outcome domain, in keeping with meta-analytic conventions. However, given heterogeneity across studies and the need for sufficient n in each category for meaningful moderator analyses, the study designs were pooled into a repeated measures meta-analysis. There were large effect sizes for global outcomes (g=1.37) and PTSD/trauma outcomes (g=1.12). More moderate effect sizes were evident for internalizing symptoms (g=0.74), self-appraisal (g=0.63), externalizing symptoms (g=0.52), and sexualized behavior (g=0.49), while small effects were found for measures of coping/functioning (g=0.44), caregiver outcomes (g=0.43), and social skills/competence (g=0.38). Effects were maintained at follow-up more than six months after treatment for some outcome domains but not others. Studies represented diverse treatment approaches, and most treatments were effective in symptom reduction. Presence of probable moderators of treatment outcome varied across symptom domains, reflecting importance of targeting therapy to individual needs.

A meta-analysis of the effects of psychotherapy with adults sexually abused in childhood

This paper presents the results of a meta-analysis of the treatment outcome studies of different types of psychotherapeutic approaches for adults sexually abused as children. There were 44 studies included comprising 59 treatment conditions, and most of the studies aimed to treat the psychological effects of childhood sexual abuse. Separate meta-analyses were conducted according to study design and outcome domain, in keeping with meta-analytic conventions. For most outcome domains, there was remarkable consistency in overall effect sizes across study design. Effect sizes were predominantly of moderate magnitude for post-traumatic stress disorder or trauma symptoms (g=0.72-0.77), internalizing symptoms (g=0.68-0.72), externalizing symptoms (g=0.41-0.53), self-esteem (g=0.56-0.58), and global functioning or symptoms (g=0.57-0.60). Studies measuring interpersonal functioning outcomes had inconsistent effect sizes across study design. Effects were largely maintained at follow-up, although relatively few studies provided follow-up data. A number of moderating variables were examined given the inherent heterogeneity of the studies. Moderator analysis revealed a variety of variables, particularly treatment characteristics, that were associated with better outcomes. However, different variables were identified for the diverse outcomes that were measured, emphasizing the importance of moderator analysis in looking beyond overall treatment effects to ascertain specific elements that confer additional benefit in therapy for the diverse psychological effects of child sexual abuse.

Differentiating classroom climate concepts: Academic, management, and emotional environments

Abstract Extensive research has validated the relationship between classroom climate and students’ social, motivational, and cognitive development. Despite improved methods of measurement, the construct itself is still nebulous and hard to delineate. One reason is that there are different dimensions to classroom climate. We examine the literature and suggest that there are three differentiable components: (1) academic, referring to pedagogical and curricular elements of the learning environment; (2) management, referring to discipline styles for maintaining order; and (3) emotional, the affective interactions within the classroom. While these components overlap, emotional climate is the least recognised or studied, and yet equally consequential. Based on our theoretical and empirical work we outline some of the characteristics of the emotional environment. We argue for the importance of treating emotional climate as a distinct aspect of classroom climate. As a concept, the emotional climate of the classroom is superordinate to other classroom climate domains, since it interfaces with the conventional academic and management elements of effective learning environments.

Moderators of Psycho-Oncology Therapy Effectiveness: Meta-Analysis of Therapy Characteristics

As part of a larger meta-analysis seeking moderators of the effectiveness of psycho-oncological interventions, this report focuses on intervention types and characteristics, including protocol components, means of delivery (mode, dose, and therapist variables), and mechanisms of effectiveness. The data set comprised 146 published and unpublished prospective controlled trials with outcomes of anxiety, depression, and distress. Analyses took into account two moderators from analysis of study design features. The authors conclude that each of the four main professional therapy types (education, relaxation, cognitive behavior therapy (CBT), and expressive-support) has effect and that it is more important to focus on participant variables, notably, elevated baseline distress. Therapy components delivered by nonprofessionals and interventions that affect the patient indirectly show potential. Recommendations for practice and research are made.

Understanding the structure of children’s emotion-regulation strategies:

Emotion regulation is a central feature in human emotional development. However, measures based on children’s observable emotion regulation behaviors are largely absent. An inventory of children’s emotion regulation strategies was developed from current measures and four focus group discussions with experts in child behavior and emotion. From there, a 103-item inventory of observable emotion regulation strategies was developed. Multidimensional scaling was used to elicit and analyze similarity data, generated by participants with lay and expert knowledge in children’s emotion regulation engaging in a series of objective sorting tasks. This created a type of “collective working model” which reflects the internal structure of the item collection. The resulting framework provides a model that overlays current theoretical models, allows these models to be discussed and expanded, and the resultant Children’s Emotion Regulation Inventory (ChERI) carries potential usefulness for research or clinical applications.

Stigma in Myalgic Encephalomyelitis and its association with functioning

ABSTRACT Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is categorised by the World Health Organisation as a neurological condition. It is poorly understood and people with ME/CFS report experiencing stigma. Research suggests that stigma might be linked to functional ability. Purpose: This study investigated the relationship of stigma to factors associated with functional ability. Additionally, the use of standardised measures allowed for comparison of stigma severity in ME/CFS to other neurological conditions. Method: A convenience sample of 206 people diagnosed with ME/CFS completed mailed or online self-report standardised measures of stigma, health, ability to participate in social roles and activities, and their satisfaction with this ability. Findings were compared to published data for three neurological conditions. Results: Stigma scores were significantly correlated (p < .0001) with all self-report health and functional measures (range: −.30 to −.42). The ME/CFS sample reported higher levels of stigma (d = 1.30) and lower levels of health (d = 1.86–2.16) and functioning (d = 1.63) than the comparison conditions. Conclusions: Consistent with studies over the last two decades, people with ME/CFS report higher levels of stigma when compared to the other conditions. The stigma is not just associated with health but also with specific measures of functional ability.

Measuring Psychological Inflexibility in Children and Adolescents: Evaluating the Avoidance and Fusion Questionnaire for Youth

The Avoidance and Fusion Questionnaire for Youth (AFQ-Y8) was developed to measure psychological inflexibility. Although the questionnaire is a well-known tool in clinical practice, its psychometric properties have not been widely investigated in the target population of children and adolescents. The purpose of this study was to investigate the factor structure and validity of the AFQ-Y8 (N = 1,572, mean age 15.39 years, girls 51%) on a Hungarian sample. We also tested the invariance of the measurement model across two age groups (11-14 and 15-20 years old). Results confirmed the single-factor structure of the AFQ-Y8. Psychological inflexibility was also found to be positively related to emotional instability, externalizing, and internalizing problems. Furthermore, psychological inflexibility explained the variance of life satisfaction when personality dimensions, emotional, and behavioral problems were accounted for. Measurement invariance across age groups was partially supported. These results suggest that the AFQ-Y8 is a reliable and valid instrument for assessing psychological inflexibility in children and adolescents.

Addressing Anger, Stress, and Alcohol-Related Difficulties in the Military: An ACT Intervention

The use of alcohol to manage emotion is a common technique seen in military service personnel, the implication of which is evident in the relationship between alcohol misuse and mood disorders. However, investigations into transdiagnostic treatments aimed at addressing the common underlying processes to these problems in military personnel are lacking. The present study aimed to investigate the efficacy of a real-world Acceptance and Commitment Therapy (ACT)-based intervention undergone by 262 military personnel. A quasi-experimental prepost design was employed (interim 1 month postintervention) with a waitlist control group utilized to compare differences over time between those who promptly completed the week-long intervention course and the delayed waitlist participants. In line with predictions, the intervention group showed greater improvement (cf. preintervention waitlist group) in emotion management, and greater reductions in levels of alcohol consumption, aggression, anxiety, stress, and perceptions of others being responsible for their circumstances. No significant differences were found in the comparison of both groups’ 1-month postintervention results (i.e., both groups evidenced similar improvements); suggesting having to wait to start the course had little effect on its impact. The results suggest the course holds promise for helping military service personnel improve a range of psychosocial outcomes. Further testing with a more rigorous methodology is recommended, as is using a more proactive approach in the promotion and implementation of future courses.

Understanding the social emotional practices of therapists

Abstract Emotions are central to the therapy process and skilful use by therapists of client emotion is an essential catalyst to client change. However, the contribution of emotion to the therapy process and how therapists’ social emotional skills are incorporated into psychological practice is still unclear. Using a statistical method for mapping psychological constructs, therapists’ social emotional skills were transformed into a “map” with three spatial dimensions, which was supported by comparative reliability checks. The nature of social emotional skills was further investigated by administering a Q-Sort of emotional practice items to 47 therapists. Ten highly applicable clusters of social emotional skills across seven style patterns with therapists were identified. Tentative links were drawn between demographic data and both clusters and therapist styles. These findings suggest therapists’ social emotional skills can be organised into meaningful clusters and that therapists can be styled according to their responses across these clusters. Furthermore, gaps identified in the model suggest possible “blind spots” in the literature. The implications of these findings are significant for training and practice.