Enhancing information pertaining to client characteristics to facilitate evidence-based practice.

OBJECTIVE: Evidence-based practice (EBP) includes utilization of empirically supported treatments, application of clinical expertise, and consideration of client characteristics. The following brief report aims to elucidate barriers in the study and dissemination of research regarding these client characteristics. DESIGN: Authors examined empirical papers cited on psychologicaltreatments.org (N = 338) and categorized each according to efficacy evidence available pertaining to gender, race/ethnicity, and socioeconomic status (SES). RESULTS: Gender was most commonly considered (7% of studies), with less than 2% of studies analyzing efficacy in relation to race/ethnicity or SES. CONCLUSIONS: Available findings are summarized according to disorder. Researchers are encouraged to attend to client variables in efficacy studies and suggestions are offered for training students to include client variables in EBP.

The effect of chewing gum flavor on the negative affect associated with tobacco abstinence among dependent cigarette smokers.

Many smokers relapse during cessation attempts due to increases in negative affect. Previous research has shown that chewing confectionary chewing gum appears to lessen the severity of acute nicotine withdrawal symptoms and help individuals who are trying to reduce smoking in part due to the flavor of the gum chewed. The current study compared the effects of three flavored gums to a No Gum Control during 48-hour cessation periods for young dependent smokers. Forty-nine smokers participated in three experimental conditions (peppermint, vanilla, and baked apple cardamom flavored gum) as well as a No Gum Control across four weeks while abstaining from smoking for 48-hours each week. Compared to the No Gum Control, participants in the Gum conditions reported lower levels of anxiety, dysphoria, and tension. Vanilla and baked apple cardamom flavored gum resulted in lower levels of negative affect while peppermint flavored gum was not different from the No Gum Control. These findings indicate that some flavors of gum are effective in reducing the negative affect associated with nicotine withdrawal and may serve as a valuable tool in helping smokers quit.

An examination of applicant characteristics of successfully matched interns: is the glass half full or half empty and leaking miserably?

Although the "balance" between the number of potential interns and the number of internship slots needs be addressed, it is imperative that more attention be devoted to examining applicant and program characteristics that result in a successful match. To that end, the current study included pre- and post-match data provided by 330 applicants of the 2009 Association of Psychology Postdoctoral and Internship Centers Match system. In this sample, we found very little evidence that applicant characteristics are related to match outcome. Suggestions to applicants and directors of training are provided and understudied variables and needed analyses are identified. Policy considerations are discussed in terms of not only resolving the supply and demand imbalance but also improving the application process and clearinghouse system.

Impulsivity and the role of smoking-related outcome expectancies among dependent college-aged cigarette smokers.

The relationship between trait-impulsivity and smoking expectancies on smoking progression in undergraduate college students was examined over a 48-hour period of smoking abstinence. Participants were forty-nine college-aged dependent cigarette smokers who completed measures designed to assess impulsivity, nicotine dependence, and smoking expectancies. Using a series of multilevel models, impulsivity by time analyses indicated significant differences in positive reinforcement expectancies, [F (2, 94)=3.19, p<.05], but not in negative reinforcement expectancies, [F (2, 94)=0.49, p=.61]. Simple slopes analyses indicated that heightened trait-impulsivity predicted greater increases in positive reinforcement outcome expectancies at 48 h of abstinence. Level of impulsivity, however, was not related to changes in negative reinforcement expectancies. Results indicate that during an abstinence period, college students higher in trait-impulsivity may be more prone to relapse due to stronger beliefs about the positive effects from smoking a cigarette. These findings highlight the importance of understanding the interaction of personality and cognitive factors when working with young adult smokers wishing to quit this health-compromising behavior.

Impulsive errors on a Go-NoGo reaction time task: disinhibitory traits in relation to a family history of alcoholism.

BACKGROUND: Behavioral undercontrol may contribute to risk for alcoholism in vulnerable persons. We predicted that healthy young adults with a family history of alcoholism (FH+) who also displayed externalizing behavior characteristics (low scores on the California Psychological Inventory Sociability Scale; CPI-So) would exhibit more impulsive responding (false alarms) on a Go-NoGo reaction time task. METHODS: Subjects were 230 healthy volunteers, 18 to 30 years of age with no history of alcohol or drug dependence. The task included 100 trials: 60 of "Go," calling for a button press, and 40 of "NoGo," or "XX," calling for inhibiting a response. Data analysis involved a signal detection analysis of performance with subsequent group comparisons for rates of impulsive responding indicated by False Alarms (responses to NoGo signals). RESULTS: CPI-So scores were lower in FH+ than in FH- (p < .000001) indicating a greater clustering of disinhibitory tendencies in these persons. FH, CPI-So scores, and Gender together predicted false alarm rates, accounting for 4.9% of the variance, F = 3.89, p = 0.009. False alarms were associated with low CPI-So scores, F = 5.15, p = 0.024, and being male, F = 6.27, p = 0.013, but not with FH once these variables were accounted for. CONCLUSIONS: A disinhibited temperament may underlie a behavioral impulsivity that contributes to elevated risk for future alcoholism, especially among FH+ males.

Teaching evidence-based practice: implications for psychology.

A movement advocating the use of evidence-based practice (EBP) is increasingly influencing health care and the practice of psychology. Thus, teaching evidence-based practice in psychology (EBPP) is critical to the preparation of future health service psychologists. In this article, the authors address common myths associated with EBP, propose core components involved in teaching EBPP, and describe an example of how such training can be incorporated into a professional psychology education and training curriculum.

Working memory and decision-making biases in young adults with a family history of alcoholism: studies from the Oklahoma family health patterns project.

BACKGROUND: Alcohol misuse is more common in persons with a family history of alcoholism (FH+) than in those with no such history (FH-). Among FH+, behavioral disinhibition and male sex seem to signal the presence of an increased risk. METHODS: This study examined cognitive and behavioral characteristics of 175 nonabusing 18- to 30-year-olds, 87 FH+ and 88 FH-, who were further characterized by their degree of behavioral disinhibition using the Sociability scale of the California Personality Inventory. Working memory and decision making were tested using the Stroop Color-Word Test and the Iowa Gambling Task, a simulated card game. RESULTS: Persons with a family history of alcoholism who were behaviorally disinhibited displayed significantly greater interference on the Stroop task than the other subgroups. On the Iowa Gambling Task, FH+ males, but not the females, were significantly more attentive to financial gains than other subgroups, and they had greater consistency in their choice behaviors. CONCLUSIONS: Persons with a family history of alcoholism, in combination with behavioral disinhibition, appears to signal working memory deficits and in combination with male sex indicates an attraction to the rewarding aspects of a risk-taking challenge. These findings are not secondary to heavy exposure to alcohol or other drugs, but instead reflect intrinsic risk-related familial and personal characteristics of the subjects.

Recruitment of healthy participants for studies on risks for alcoholism: effectiveness of random digit dialling.

AIMS: To compare the effectiveness of two strategies for recruiting healthy research volunteers. METHODS: Demographic characteristics and recruitment costs of participants who completed a laboratory study examining risk factors for alcoholism recruited through random digit dialling (N = 11) and community advertisements (N = 102) were compared. RESULTS: Advertisement yielded a more representative sample [76% Caucasian, less well educated (M = 15.2 years, SEM = 0.2; P < 0.05), more equally divided by family history of alcoholism (43% FH- and 57% FH+), and lower in SES (M = 42.8, SEM = 1.3; P < 0.05)] and was more cost effective (72 dollars vs 2272 dollars per participant) than random digit dialling. CONCLUSIONS: Findings are relevant to alcohol researchers trying to determine the recruitment strategy that will yield the most representative sample at the lowest cost.

Blunted hypothalamic-pituitary-adrenocortical axis responsivity to stress in persons with a family history of alcoholism.

Abstinent alcoholics show a blunted stress cortisol response that may be a consequence of drinking or a preexisting risk marker. We tested cortisol responses to psychological stress in 186 18-30 year-old, healthy social drinkers having no personal history of alcohol or drug dependence, 91 of whom had one or two alcoholic parents (FH+) and 95 having no family alcoholism for two generations (FH-). We predicted that, similar to alcoholic patients, the FH+ would have reduced stress cortisol responses that would be partially determined by their temperament characteristics, specifically antisocial tendencies as measured by the California Psychological Inventory. On a stress day, subjects performed continuous simulated public speaking and mental arithmetic tasks for 45 min, and on a control day they sat and rested for the same time period. The FH+ who were low in sociability had smaller cortisol responses than FH-, high-sociability persons (t=2.27, p=.02). These two groups were not different in diurnal cortisol secretion patterns or affective responses to the stressors. Persons with a familial risk for alcoholism who have more antisocial tendencies may have altered central nervous system responses to emotionally relevant social challenges. Disrupted cortisol stress responses may serve as a risk marker for the development of substance use disorders.

Workforce competencies in behavioral health: an overview.

Competency-based training approaches are being used more in healthcare to guide curriculum content and ensure accountability and outcomes in the educational process. This article provides an overview of the state of competency development in the field of behavioral health. Specifically, it identifies the groups and organizations that have conducted and supported this work, summarizes their progress in defining and assessing competencies, and discusses both the obstacles and future directions for such initiatives. A major purpose of this article is to provide a compendium of current competency efforts so that these might inform and enhance ongoing competency development in the varied behavioral health disciplines and specialties. These varied resources may also be useful in identifying the core competencies that are common to the multiple disciplines and specialties.

Salivary cortisol concentrations are associated with acute nicotine withdrawal.

Research has shown that smoking commercial cigarettes results in slight elevations in cortisol levels relative to smoking nicotine-free cigarettes. It is not clear however, whether cortisol concentrations are associated with nicotine withdrawal symptoms among regular cigarette smokers. Nicotine withdrawal symptoms resemble a stress response, and may therefore contribute to cortisol production. This preliminary study focuses on assessing the association between salivary cortisol levels and subsequent levels of self-reported withdrawal and craving symptoms. Twenty male smokers were studied during a 4-h deprivation period. All participants smoked an initial cigarette shortly after arrival and were informed that they would be unable to smoke for the remainder of the session. The session consisted of each participant watching a movie, and then waiting in the laboratory for two consecutive 30-min intervals. Self-reported nicotine withdrawal and craving were assessed four times and salivary cortisol, five times, during the session. Results show that baseline cortisol concentrations predicted subsequent withdrawal symptoms and craving measured using the Tobacco Withdrawal Symptom Checklist (WSC). This suggests that salivary cortisol may contribute to, or be a marker of, nicotine withdrawal symptoms.

Competencies conference: future directions in education and credentialing in professional psychology.

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was organized around eight competency-focused work groups, as well as work groups on specialties and the assessment of competence. A diverse group of psychologists participated in this multisponsored conference. After describing the background and structure of the conference, this article reviews the common themes that surfaced across work groups, with attention paid to the identification, training, and assessment of competencies and competence. Recommendations to advance competency-based education, training, and credentialing in professional psychology are discussed. This is one of a series of articles published together in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

The scientifically-minded psychologist: science as a core competency.

At the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology, the Scientific Foundations and Research Competencies Work Group focused on identifying how psychologists practice scientifically. This article presents the subcomponents associated with the core competency of scientific practice. The subcomponents include: 1). access and apply current scientific knowledge habitually and appropriately; 2). contribute to knowledge; 3). critically evaluate interventions and their outcomes; 4). practice vigilance about how sociocultural variables influence scientific practice; and 5). routinely subject work to the scrutiny of colleagues, stakeholders, and the public. In addition, the article briefly discusses how the depth of training for and assessment of each subcomponent will vary by training model. Implications and future directions for individual psychologists, training programs, and the profession are discussed. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Effect of non-nicotinic moist snuff replacement and lobeline on withdrawal symptoms during 48-h smokeless tobacco deprivation.

The present study investigated the effects of two herbal components (BACCOFF and DIPSTOP) of a commercially available smokeless tobacco treatment program for reducing subjective withdrawal symptoms during deprivation. One component, BACCOFF, is a non-nicotinic chew. The second component, DIPSTOP, is a liquid containing the alkaloid lobeline, which to some extent mimics peripheral nicotinic effects. All participants (N = 22 males) were placed in four conditions: BACCOFF + DIPSTOP, BACCOFF + placebo control, DIPSTOP, and placebo control only. The conditions involved 48 h of deprivation, and subjects were exposed to one condition per week for 4 weeks. Withdrawal measures were taken at baseline, 24 h, and 48 h of deprivation. Individuals were randomly assigned, and conditions were counterbalanced. Results showed that BACCOFF, as compared with DIPSTOP, significantly reduced withdrawal symptoms but not craving. These data suggest that behavioral/sensory substitutes' influence on withdrawal might be routed through the product's ability to approximate the preferred moist snuff.