"Echo attributions" and other risks when publishing on novel therapies without peer review.

A special series on Thought Field Therapy in the Journal of Clinical Psychology provides an opportunity for psychologists to learn about techniques and theories outside the mainstream of our field. Unfortunately, by publishing this series of manuscripts without meeting the standards of peer review, the Journal also provides an avenue for the misuse of its good reputation and the improper promotion of untested methods. "Echo attributions" can be made whereby an author attributes the source of his own words to the professional journal in which the text appears. Historical examples illustrate that such misuse of scientific journals and institutions occurs. A formal statement of guidelines is needed to instruct authors on appropriate versus unethical representations of their publications.

Conceptual and ethical issues in therapy for the psychological problems of gay men, lesbians, and bisexuals.

Reviewed here are a number of conceptual and ethical issues surrounding the study and treatment of gay men, lesbians, and bisexuals (GLB), with particular emphasis on the frequently overlooked political and ethical dimensions of what therapists choose to treat, indeed, on the goals patients themselves want to work towards. Several issues are discussed, including the relevance and irrelevance of sexual orientation and the role of therapist biases in assessment and treatment planning, the need for better understanding of how the problems of GLB patients are construed and the associated dangers of stereotyping, the challenges of coming out and the ways therapists can help patients make the decision and how to implement it, the extra effort required to be a GLB person in terms of the formation of an unconventional social and sexual identity, the trust issues that can arise when one partner in a committed relationship requests protected sex, the challenges and rewards of parents "coming out" as family members of a gay son or daughter, the social invisibility of lesbians and the deleterious effects this can have on them, social support issues for GLB youth, and the need for professionals to take a broad, institutional community psychology perspective to their study and treatment of GLB individuals.

Stepped care: doing more with less?

Several issues concerning stepped care are discussed: the constraints of using Diagnostic and Statistical Manual of Mental Disorders diagnoses in randomized clinical trials (RCTs), the importance of basic and process research, the unintended negative effects of exaggerated claims of effectiveness and efficiency, the limits of RCTs in evaluating improvement and deterioration, the self-correcting nature of stepped care, the link between stepped care and empirically supported treatments, clinical judgment in clinical work, the concept of the least restrictive alternative, the costs of using low-intensity but ineffective psychosocial treatments, and the costs of both ineffective and effective psychotropic drug therapy. An analysis of stepped care can lead to an appreciation that the dialectic operating between science and practice affords an opportunity to synthesize the seemingly irreconcilable standards and needs of researchers and clinicians.

Articulated thoughts of maritally violent and nonviolent men during anger arousal.

The cognitive correlates of anger arousal were investigated in community-based samples of maritally violent (MV), maritally distressed-nonviolent (DNV), and maritally satisfied-nonviolent (SNV) husbands. Participants performed the Articulated Thoughts in Simulated Situations (ATSS) paradigm while listening to anger-arousing audiotapes. Trained raters coded for irrational beliefs, cognitive biases, hostile attributional biases, and anger control statements. Results indicated that MV men articulated significantly more irrational thoughts and cognitive biases than DNV and SNV men. MV men articulated more hostile attributional biases than DNV and SNV men across all ATSS scenarios. SNV men, however, articulated more anger control statements during ATSS anger arousal than MV or DNV participants. Discriminant function analyses indicated that specific thoughts discriminated between the groups and differentiated mildly from severely violent participants. ATSS cognitive distortions (a) were not correlated with questionnaire measures of cognitive distortion, and (b) were superior to questionnaire measures in discriminating between the groups. The findings are interpreted in light of recent advances in understanding the relationship between information processing, anger, and marital aggression.

Being bolder with the Boulder model: the challenge of education and training in empirically supported treatments.

A number of factors interfere with the realization of the scientist-practitioner model of training in applied psychology. Resistance to empirically supported treatments (ESTs) may arise from both academic faculty and internship supervisors who have an investment in approaches of longer standing but with less empirical justification. A possible problem with ESTs, however, is that they typically derive from studies that use treatment manuals, which, originally developed to define the independent variables in psychotherapy research, have become central in graduate training. Because manuals can constrain clinician behavior and because they are almost always associated with categorically defined diagnostic categories, one can lose sight of the idiographic analysis of single cases. Reliance on manualized treatment can discourage functional analysis of the complexities of individual cases. Achieving some synthesis of this dialectic poses a significant challenge to the continuing development of the science and profession of applied psychology.

Think-aloud approaches to cognitive assessment and the articulated thoughts in simulated situations paradigm.

In addition to widely used endorsement methods, one way to get at people's thoughts is to have them verbalize while engaged in a task or situation. The articulated thoughts in simulated situations (ATSS) paradigm is a think-aloud approach to cognitive assessment that has several advantages: an unstructured production response format, on-line rather than retrospective assessment, situational specificity and control, and flexibility of situation and cognitions. The authors review experiments that have examined articulated thoughts in clinically relevant contexts. ATSS does have certain limitations and further research into its psychometric properties is needed, but it seems promising as a versatile and adaptable method of cognitive assessment, especially when little is known of the cognitive terrain of interest.

An appraisal of rational-emotive therapy.

Albert Ellis's rational-emotive therapy (RET) is scrutinized on several conceptual and empirical grounds, including its reliance on constructive assessment and its ethical stance. Its professional impact thus far exceeds its scientific status. Opinion varies on how even to define irrational beliefs; 1 consequence is problems in assessing them. Meta-analytic reviews provide support for the general utility of RET, but more qualitative reviews question both the internal and external validity of much of the published research. Lacking are process studies that can shed light on the mechanisms of therapeutic change, a situation likely due to the complexity of RET and to a lack of consensus as well about its very definition. Perhaps more progress can be achieved by forsaking studies of RET as a package and shifting instead to examination of specific therapeutic tactics in particular circumstances.

Cognitive bias in the articulated thoughts of depressed and nondepressed psychiatric patients.

Beck's cognitive theory of depression postulates several types of cognitive bias among depressed patients. Empirical studies supporting this hypothesis have usually used questionnaire "endorsement" measures of cognition, which may suggest responses to subjects. We used the articulated thoughts during simulated situations (ATSS) method of cognitive assessment in comparing cognitive processes of 15 outpatients with major depression with those of 15 nondepressed psychiatric outpatients in three simulated situations. Depressed patients exceeded nondepressed patients in cognitive bias only in the negative (not the neutral or positive) simulated situation. Discussion centered on the possible utility of ATSS for research on cognition in stressful situations.

Relaxation, reduction in angry articulated thoughts, and improvements in borderline hypertension and heart rate.

An intensive 7-week relaxation therapy was evaluated in a sample of unmedicated borderline hypertensive men. All subjects were provided state-of-the-art medical information regarding changes known to affect hypertension favorably, e.g., lower salt intake and regular exercise. In addition, relaxation subjects were trained in muscle relaxation that entailed audiotaped home practice. As predicted, relaxation combined with hygiene lowered blood pressure more than did hygiene alone. Neither treatment favorably affected a paper-and-pencil measure of anger but relaxation did lower anger-hostility on a new cognitive assessment procedure, Articulated Thoughts in Simulated Situations (ATSS). Moreover, ATSS anger-hostility reduction was correlated with blood pressure or heart rate reductions, for all subjects and especially for those in the Relaxation condition. This represents the first clinically demonstrated link between change in a cognitive variable and change in cardiovascular activity. Finally, results were especially strong in subjects high in norepinephrine, suggesting its importance in essential hypertension.

Noradrenergic hyperactivity in primary hypertension; central and peripheral markers of both behavioral pathogenesis and efficacy of sympatholytic and relaxation therapy.

The effects of clonidine or relaxation therapy were determined in two separate groups of patients with primary hypertension. Ten patients were treated with clonidine monotherapy for 3 months. There were concurrent reductions of blood pressure, plasma and CSF norepinephrine, all p less than 0.01. The changes of blood pressure and norepinephrine were correlated, p less than 0.05 and 0.01, respectively. Thirty patients received hygienic instructions, and 17 of them had relaxation training in addition. Relaxation lowered blood pressures, p less than 0.01, the reduction of blood pressure was related to baseline plasma norepinephrine, p less than 0.05, and greater in patients with "raised" plasma norepinephrine, p less than 0.02. Plasma norepinephrine was lowered after hygienic therapy, p less than 0.05, the change was not significant after relaxation training. Arterial pressure elevation appears to be related to raised plasma norepinephrine. This noradrenergic hyperactivity is a marker for blood pressure responsiveness to sympatholytic therapy with clonidine or relaxation techniques.

Sexual orientation stereotypy in the distortion of clinical judgment.

It has been suggested that if a person's sexual orientation is unconventional, their nonsexual psychological problems will be construed in sexual terms to a marked degree. An experiment is described in which undergraduates read a case study of a man troubled by depression, catastrophizing, heavy drinking, and other maladaptive behavior not obviously related to his sexuality. Half the subjects were told that the patient had had several extramarital affairs, exclusively with men; the others, affairs exclusively with women. Blind content analyses of subject responses revealed that when the man was described as having had homosexual involvements, he was more likely to receive a diagnosis of sexual deviation or have his nonsexual diagnosis justified on the basis of homosexuality, more likely to have his sexual or marital life investigated, and more likely to have his sexuality construed as important in the etiology of his nonsexual psychological problems. The authors' analogue findings confirm cautions voiced by previous researchers regarding predictable distortions to which clinicians may be susceptible in their interpretation of patient problems when homosexuality is part of the patient's past or present life-style.

Homosexuality and the ethics of behavioral intervention: Homosexuality, the ethical challenge.

It is suggested that behavior therapists have not attended sufficiently to the factors influencing the desire of some homosexuals to change their sexual orientation. Therapists of all persuasions constantly make decisions for their voluntary clients, encompassing both the goals of therapy and the means to be used to achieve those goals. A perusal of the psychotherapy and behavior therapy literature indicates that therapists generally regard homosexuality as undesirable, if not pathological. Since professionals are unlikely to work on treatment procedures unless they see a problem, it is probable that the very existence of change-of-orientation programs strengthens societal prejudices against homosexuality and contributes to the self-hate and embarrassment that are determinants of the "voluntary" desire by some homosexuals to become heterosexual. It is therefore proposed that we stop offering therapy to help homosexuals change and concentrate instead on improving the quality of their interpersonal relationships. Alternatively, more energy could be devoted to sexual enhancement procedures in general, regardless of the adult gender mix.