Supervisor versus self-assessment of trainee competence: Differences across developmental stages and competency domains.

OBJECTIVES: This research aimed to systematically examine supervisor-trainee differences in assessments of trainee competencies across domains and developmental stages. METHODS: Trainees and supervisors (N = 141 dyads) independently rated trainee performance at the end of placements using the Clinical Psychology Competencies Rating Scale. Based on the number of placement hours completed at the time competence was assessed, the 141 trainees were assigned to three developmental levels (61, 42, and 31 in the groups, respectively). Trajectories of 10 different competencies and trainee-supervisor differences for these competencies were examined across three developmental levels. RESULTS: Compared to their supervisor ratings, trainees underestimated their competence during early stages of training, with this discrepancy reducing at Level 2 and reversing into an overestimation at Level 3. Compared to their own ratings for overall competence, trainees rated Relational and Communication, Reflective Practice, and Professionalism domains as relative strengths, and rated their competence on assessment and intervention domains as relative weaknesses. CONCLUSION: Growth trajectories derived from supervisor assessments were much flatter than trajectories derived from trainee assessments. As predicted by the impostor theory of practitioner development, trainees significantly underestimated their competence early in training. The trend for trainees to overestimate their competence toward the end of their training is a potential concern that warrants further research.

Barriers to the use of exposure therapy by psychologists treating anxiety, obsessive-compuslive disorder, and posttraumatic stress disorder in an Australian sample.

BACGROUND: Exposure therapy is a core component of the evidence-based treatment of anxiety, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Despite this, many clinicians fail to use exposure therapy in clinical practice, with research highlighting a number of potential barriers. Those findings raise serious concerns regarding the effective dissemination and delivery of evidence-based treatments that in turn have a major impact on client care and cost-effectiveness of psychological interventions. AIMS: The present study aims to examine barriers to the use of exposure therapy in the clinical practice of Australian psychologists treating anxiety, OCD and PTSD. METHOD: One hundred registered psychologists, aged between 23 and 71 years and 84% female, participated in this study via online survey. RESULTS: Results suggest that the most common barriers to the use of exposure therapy include lack of confidence, negative beliefs about exposure therapy, insufficient underpinning theoretical knowledge, client-specific barriers, and logistical limitations. CONCLUSIONS: Future research may further examine those barriers and the components of additional training and supervision that can increase the uptake of exposure therapy, particularly in clinical areas where it is a gold standard of practice.

Utilisation and predictors of use of exposure therapy in the treatment of anxiety, OCD and PTSD in an Australian sample: a preliminary investigation.

BACKGROUND: Cognitive-behavior therapy (CBT) is known to be an effective treatment for the anxiety and related disorders, with exposure therapy being a key component of this treatment package. However, research on the use of exposure therapy in clinical practice has presented mixed results, potentially due to differences in samples and training programs across countries. The present study aimed to extend upon existing research by examining the use and predictors of use of exposure therapy in a sample of psychologists working in clinical practice in Australia who treat clients with an anxiety disorder, obsessive compulsive disorder (OCD) or post-traumatic stress disorder (PTSD). METHODS: One hundred registered psychologists (Mage = 40.60; SD = 10.78; range 23 to 71 years; 84% female) participated in an online study investigating their clinical practices. RESULTS: Results suggested that while the general use of exposure therapy is high, the use of disorder specific techniques was considerably lower, particularly for anxiety disorders and PTSD but not OCD. Psychology registration status and level of training were positively associated with use of exposure therapy as was the experience in treating anxiety disorders. CONCLUSIONS: These findings suggest that further or ongoing professional training may be required to optimize the use of disorder specific techniques.

A short scale to evaluate supervision and supervisor competence-The SE-SC8.

There is an urgent need for instruments to evaluate supervisor competence. The current study describes the development of the SE-SC8, an eight-item version of a previously published Supervision Evaluation and Supervisory Competence scale that has adequate reliability and validity. The current study analysed data from the sample (N = 142) used in the initial validation of the full scale to identify the best set of items for a short scale before testing the scale's psychometric properties in a new study (N = 122). The SE-SC8 demonstrated good reliability and adequate convergent and divergent validity. The SE-SC8 has two overall items respectively measuring supervisor effectiveness and supervision satisfaction and six items that represent supervisory competencies, namely, (1) Openness, Caring and Support, (2) Supervisor's Knowledge and Expertise as Therapist, (3) Supervision Planning and Management, (4) Goal-Directed Supervision, (5) Restorative Competencies, and (6) Insight into and Management of Therapist-Client Dynamics and Reflective Practitioner Competencies. As with other subjective ratings, SE-SC8 scores should be supplemented by other assessments for a holistic appraisal of supervisor competence.

Developmental trajectories of competency attainment amongst clinical psychology trainees across field placements.

OBJECTIVE: This research aimed to describe the developmental trajectories of clinical psychology trainees across competency domains over multiple placements. METHOD: Competency reviews of 252 trainees were completed at mid-placement and end-placement for up to four consecutive placements by 143 field supervisors. Competency was measured across multiple domains using the Clinical Psychology Practicum Competencies Rating Scale. RESULTS: There was an overall ascending stepped pattern occurring across all competency domains from early to late placements. The starting point of competency ratings varied across domains with the largest discrepancy between Response to supervision (highest) and Intervention competencies (lowest). There were significant increases from mid-placement to end-placement for all competencies within each of the four placements. There were few significant decreases in competency between different placements and these were largely restricted to the transition from placement one to placement two. CONCLUSIONS: This research has the potential to be used as a benchmark to indicate expected levels of competency attainment for trainees across their training, allowing for early identification of difficulties and more targeted remediation plans.

The age-related positivity effect in electronic gambling.

BACKGROUND: Older adults are increasingly spending time and money playing electronic gambling machines (EGMs). The current study assessed whether the age-related positivity effect influences responding to various EGM outcomes, including wins and losses of equivalent magnitude and frequency. We also explored cognitive mechanisms potentially underpinning the positivity effect. METHODS: We recorded the skin conductance response (SCR) of healthy older and younger adults while they played for wins, losses, and fake wins (losses disguised as wins). After every win and fake win, participants were forced to choose red or black to either double their win or lose it. They also provided ratings of enjoyment and excitement, estimated number of wins and losses, and completed measures of cognitive function. RESULTS: Young and older adults demonstrated larger SCRs to wins relative to losses. When these wins and losses were of equivalent magnitude and frequency following a double-or-nothing scenario, only older adults responded more to a win than a loss. There were no age group differences in excitement and enjoyment, but older adults were more accurate than young adults in their recall of wins and losses. CONCLUSION: During EGM play, young and older adults demonstrate similar patterns on autonomic arousal. However, young adults' responding suggests generalized excitement, whereas older adults respond more to the prospect of financial gain.

Does size matter? An examination of problem gamblers' skin conductance responses to large and small magnitude rewards.

Previous research has shown that individuals with substance use disorder equally value small and large magnitude rewards. This has led some researchers to conceptualize the problematic behaviors associated with this disorder as being, at least in part, caused by a deficiency in processing reward stimuli. Considering the documented similarities between substance use disorder and disordered gambling, the current study sought to investigate whether problem gamblers also display such an aberrant pattern of incentive processing. Skin conductance responses (SCRs) to small and large magnitude wins were recorded from 16 problem gamblers (PGs) and 16 healthy controls (HCs) while they completed a computer-simulated electronic gaming machine task. The results show that, while large wins elicited greater SCRs compared to small wins for the HC group, no difference in SCR amplitude was found following large and small wins in the PG group. These findings suggest that problem gamblers may be less effective at evaluating the value of incentives, and are discussed in terms of relevant theoretical frameworks.

Brief Online Training with Standardised Vignettes Reduces Inflated Supervisor Ratings of Trainee Practitioner Competencies.

OBJECTIVE: Supervisor assessments of trainee competence are integral to ensuring that clinical psychology trainees reach competency benchmarks. The commonly used Clinical Psychology Practicum Competencies Rating Scale (CΨPRS) has been shown to elicit inflated ratings of competency. Hence, the aim of this study is to examine whether brief supervisor training reduces ratings by providing objective criteria with which supervisors can assess trainee competency. METHOD: The ratings included were of 124 psychology trainees from nine Australian university clinical programmes. Of 170 supervisors, 32 completed the online training immediately prior to commencing the CΨPRS. Training required supervisors to rate the competency level described in five standardised vignettes (Beginner through to Competent). Vignette ratings, as determined by a panel of expert supervisors, were provided as feedback. A sixth calibration vignette was also rated (no feedback provided). Firstly, CΨPRS ratings from the trained and untrained supervisors were compared. Secondly, the difference between supervisor and expert ratings of the calibration vignettes were compared across trained and untrained groups. RESULTS: Trained supervisors provided lower CΨPRS ratings than untrained supervisors. In addition, trained supervisors (vs untrained supervisors) provided ratings of the calibration vignette that more accurately matched the ratings provided by the expert panel. CONCLUSIONS: Brief online training using standardised vignettes was associated with lower CΨPRS ratings. The standardised vignettes helped calibrate supervisors' ratings and likely attuned supervisors to the skills and competency levels that are expected at particular developmental stages. As a consequence, training appeared to reduce ratings, arguably resulting in more accurate assessments of trainee performance.

Sequential Processing and the Matching-Stimulus Interval Effect in ERP Components: An Exploration of the Mechanism Using Multiple Regression.

In oddball tasks, increasing the time between stimuli within a particular condition (target-to-target interval, TTI; nontarget-to-nontarget interval, NNI) systematically enhances N1, P2, and P300 event-related potential (ERP) component amplitudes. This study examined the mechanism underpinning these effects in ERP components recorded from 28 adults who completed a conventional three-tone oddball task. Bivariate correlations, partial correlations and multiple regression explored component changes due to preceding ERP component amplitudes and intervals found within the stimulus series, rather than constraining the task with experimentally constructed intervals, which has been adequately explored in prior studies. Multiple regression showed that for targets, N1 and TTI predicted N2, TTI predicted P3a and P3b, and Processing Negativity (PN), P3b, and TTI predicted reaction time. For rare nontargets, P1 predicted N1, NNI predicted N2, and N1 predicted Slow Wave (SW). Findings show that the mechanism is operating on separate stages of stimulus-processing, suggestive of either increased activation within a number of stimulus-specific pathways, or very long component generator recovery cycles. These results demonstrate the extent to which matching-stimulus intervals influence ERP component amplitudes and behavior in a three-tone oddball task, and should be taken into account when designing similar studies.

Electrophysiology of Memory-Updating Differs with Age.

In oddball tasks, the P3 component of the event-related potential systematically varies with the time between target stimuli-the target-to-target interval (TTI). Longer TTIs result in larger P3 amplitudes and shorter latencies, and this pattern of results has been linked with working memory-updating processes. Given that working memory and the P3 have both been shown to diminish with age, the current study aimed to determine whether the linear relationship between P3 and TTI is compromised in healthy aging by comparing TTI effects on P3 amplitudes and latencies, and reaction time (RT), in young and older adults. Older adults were found to have an overall reduction in P3 amplitudes, longer latencies, an anterior shift in topography, a trend toward slower RTs, and a flatter linear relationship between P3 and TTI than young adults. Results suggest that the ability to maintain templates in working memory required for stimulus categorization decreases with age, and that as a result, neural compensatory mechanisms are employed.

Reflective dialogue in clinical supervision: A pilot study involving collaborative review of supervision videos.

OBJECTIVE: To pilot an intervention involving reflective dialogue based on video recordings of clinical supervision. METHOD: Fourteen participants (seven psychotherapists and their supervisors) completed a reflective practice protocol after viewing a video of their most recent supervision session, then shared their reflections in a second session. RESULTS: Thematic analysis of individual reflections and feedback resulted in the following dominant themes: (1) Increased discussion of supervisee anxiety and the tensions between autonomy and dependence; (2) intentions to alter supervisory roles and practice; (3) identification of and reflection on parallel process (defined as the dynamic transmission of relationship patterns between therapy and supervision); and (4) a range of perceived impacts including improvements in supervisory alliance. CONCLUSIONS: The results suggest that reflective dialogue based on supervision videos can play a useful role in psychotherapy supervision, including with relatively inexperienced supervisees. Suggestions are provided for the encouragement of ongoing reflective dialogue in routine supervision practice.

Electrophysiology of facilitation priming in obsessive-compulsive and panic disorders.

OBJECTIVE: Repeated experience with stimuli often primes faster, more efficient neuronal and behavioural responses. Exaggerated repetition priming effects have previously been reported in obsessive-compulsive disorder (OCD), however little is known of their underlying neurobiology or disorder-specificity, hence we investigated these factors. METHODS: We examined event-related potentials (ERPs) and behaviour while participants with OCD, panic disorder and healthy controls (20 per group) performed a Go/NoGo task which manipulated target repetition sequences. RESULTS: Both clinical groups showed stronger reaction time (RT) priming than HCs, which in OCD was greater in a checking, than washing, subgroup. Both clinical groups had similar RT deficits and ERP anomalies across several components, which correlated with psychopathology and RT priming. In OCD alone, N1 latency tended to increase to repeated stimuli, correlated with O-C symptoms, whereas it decreased in other groups. OCD-checkers had smaller target P2 amplitude than all other groups. CONCLUSIONS: Enhanced neural priming is not unique to OCD and may contribute to salient sensory-cognitive experiences in anxiety generally. These effects are related to symptom severity and occur to neutral stimuli and in the context of overall RT impairment, suggesting they may be clinically relevant and pervasive. The results indicate overlapping information-processing and neurobiological factors across disorders, with indications of OCD-specific trends and subgroup differences. SIGNIFICANCE: This first electrophysiological investigation of OCD priming in OCD to include anxious controls and OCD subgroups allows for differentiation between overlapping and OCD-specific phenomena, to advance neurobiological models of OCD.

Reward and punishment hyposensitivity in problem gamblers: A study of event-related potentials using a principal components analysis.

OBJECTIVE: To investigate whether the latent neural correlates of incentive processing differ between problem gamblers (PGs) and healthy controls (HCs). METHODS: Event-related potential (ERP) data were derived while 16 PGs and 20 HCs played a computer electronic gaming machine (EGM) task. Psychophysiological responses to outcomes commonly encountered during EGM gambling, including Large wins, Small wins, Near-wins, and Losses, were examined using a spatiotemporal principal components analysis (PCA). Subjects also completed questionnaires that assessed their levels of impulsivity, attraction to appetitive stimuli, and avoidance of aversive stimuli. RESULTS: Losses elicited a feedback-related negativity (FRN), whereas wins elicited a feedback-related positivity (FRP) at the same latency and topography. PGs exhibited both attenuated FRN amplitudes following Losses and FRP amplitudes following Wins. Greater P3b amplitudes were found following Wins compared to Losses. FRN amplitudes following Near-wins were significantly reduced compared to Losses for both PGs and HCs. Trends for reduced P3b amplitudes following all outcome types, and for similar P3b amplitudes following Large and Small wins, were found for the PG group. CONCLUSIONS: We provide evidence that PGs are hyposensitive to both positive and negative outcomes. SIGNIFICANCE: The finding that PGs are hyposensitive to reward and punishment provides valuable insight into the nature of deficit in this disorder, and provides a foundation for future research and clinical interventions.

Evaluation of psychology practitioner competence in clinical supervision.

There is a growing consensus favouring the development, advancement, and implementation of a competency-based approach for psychology training and supervision. There is wide recognition that skills, attitude-values, and relationship competencies are as critical to a psychologist's competence as are knowledge capabilities, and that these key competencies are best measured during placements, leaving the clinical supervisor in an unparalleled position of advantage to provide formative and summative evaluations on the supervisee's progression towards competence. Paradoxically, a compelling body of literature from across disciplines indicates that supervisor ratings of broad domains of competence are systematically compromised by biases, including leniency error and halo effect. The current paper highlights key issues affecting summative competency evaluations by supervisors: what competencies should be evaluated, who should conduct the evaluation, how (tools) and when evaluations should be conducted, and process variables that affect evaluation. The article concludes by providing research recommendations to underpin and promote future progress and by offering practice recommendations to facilitate a more credible and meaningful evaluation of competence and competencies.

Stimulus-to-matching-stimulus interval influences N1, P2, and P3b in an equiprobable Go/NoGo task.

Previous research has shown that as the stimulus-to-matching-stimulus interval (including the target-to-target interval, TTI, and nontarget-to-nontarget interval, NNI) increases, the amplitude of the P300 ERP component increases systematically. Here, we extended previous P300 research and explored TTI and NNI effects on the various ERP components elicited in an auditory equiprobable Go/NoGo task. We also examined whether a similar mechanism was underpinning interval effects in early ERP components (e.g., N1). Thirty participants completed a specially-designed variable-ISI equiprobable task whilst their EEG activity was recorded. Component amplitudes were extracted using temporal PCA with unrestricted Varimax rotation. As expected, N1, P2, and P3b amplitudes increased as TTI and NNI increased, however, Processing Negativity (PN) and Slow Wave (SW) did not show the same systematic change with interval increments. To determine the origin of interval effects in sequential processing, a multiple regression analysis was conducted on each ERP component including stimulus type, interval, and all preceding components as predictors. These analyses showed that matching-stimulus interval predicted N1, P3b, and weakly predicted P2, but not PN or SW; SW was determined by P3b only. These results suggest that N1, P3b, and to some extent, P2, are affected by a similar temporal mechanism. However, the dissimilar pattern of results obtained for sequential ERP components indicates that matching-stimulus intervals are not affecting all aspects of stimulus processing. This argues against a global mechanism, such as a pathway-specific refractory effect, and suggests that stimulus processing is occurring in parallel pathways, some of which are not affected by temporal manipulations of matching-stimulus interval.

Nontarget-to-nontarget interval determines the nontarget P300 in an auditory equiprobable Go/NoGo task.

Increases in the target-to-target interval (TTI) systematically enhance the amplitude of the target P300 ERP component. Research examining changes in nontarget P300 related to nontarget-to-nontarget interval (NNI) or sequential probability manipulations has produced inconsistent results, with some studies reporting no enhancement in nontarget P300 and others finding response profiles analogous to TTI effects. Our aim was to clarify these differences. All participants completed a specially designed auditory equiprobable Go/NoGo task with manipulations of TTI and NNI while their EEG activity was recorded. P300 amplitudes were extracted using temporal PCA with Varimax rotation. P3b to targets and nontargets increased systematically as respective TTIs/NNIs increased, but this change did not differ between stimulus types. The Slow Wave did not show any effect of interval, but was more positive to targets than nontargets when interval was collapsed. P3b findings show that matching-stimulus interval effects are not restricted to targets, but discrepancies relative to previous research suggest that NNI effects in P3b may depend on additional processing of nontarget stimuli.

Problem gamblers are hyposensitive to wins: an analysis of skin conductance responses during actual gambling on electronic gaming machines.

Physiological arousal is purportedly a key determinant in the development and maintenance of gambling behaviors, with problem gambling conceptualized in terms of abnormal autonomic responses. Theoretical conceptualizations of problem gambling are discordant regarding the nature of deficit in this disorder; some accounts posit that problem gamblers are hypersensitive to reward, and others that they are hyposensitive to reward and/or punishment. Previous research examining phasic electrodermal responses in gamblers has been limited to laboratory settings, and reactions to real gaming situations need to be examined. Skin conductance responses (SCRs) to losses, wins, and losses disguised as wins (LDWs) were recorded from 15 problem gamblers (PGs) and 15 nonproblem gamblers (NPGs) while they wagered their own money during electronic gaming machine play. PGs demonstrated significantly reduced SCRs to reward. SCRs to losses and LDWs did not differ for either PGs or NPGs. This hyposensitivity to wins may reflect abnormalities in incentive processing, and may represent a potential biological marker for problem gambling.

How specific are inhibitory deficits to obsessive-compulsive disorder? A neurophysiological comparison with panic disorder.

OBJECTIVE: Impaired inhibition may perpetuate repetitive symptoms in obsessive-compulsive disorder (OCD), however OCD-specific deficits have yet to be established. We investigated neural correlates of inhibition in OCD vs. healthy and anxious controls. METHODS: ERPs and reaction times (RTs) were compared between participants with OCD (n=20), panic disorder (PD; n=20) and healthy controls (HCs; n=20) during an adapted Go/NoGo task, which manipulated inhibitory difficulty. RESULTS: A classic P3 NoGo anteriorisation effect occurred across groups. Both clinical groups showed RT impairment, and similar topographical anomalies of several (P2, N2 and P3) ERP components. Notably, both clinical groups lacked the strong frontally maximal N2 component topography seen in the HCs, across stimuli. Additionally, with increasing inhibitory difficulty, N2 latency increased in HCs but not in the clinical groups. CONCLUSIONS: Unexpectedly, ERP and behavioural anomalies during inhibition in OCD were not qualitatively different to those in PD, but were generally more severe. Common general and inhibitory deficits may underlie intrusive mental phenomena in both conditions. SIGNIFICANCE: This first ERP response inhibition study in OCD to include anxious controls disconfirmed hypotheses regarding OCD-specific inhibitory deficits, indicating the importance of comparing OCD to other conditions, to evaluate neurobiological models.

Can working memory predict target-to-target interval effects in the P300?

It has been suggested that the P300 component of the ERP is an electrophysiological index of memory-updating processes associated with task-relevant stimuli. Component magnitude varies with the time separating target stimuli (target-to-target interval: TTI), with longer TTIs eliciting larger P300 amplitudes. According to the template-update perspective, TTI effects observable in the P300 reflect the updating of stimulus-templates in working memory (WM). The current study explored whether young adults' memory-task ability could predict TTI effects in P300. EEG activity was recorded from 50 university students (aged 18-25 years) while they completed an auditory equiprobable Go/NoGo task with manipulations of TTIs. Participants also completed a CogState® battery and were sorted according to their WM score. ERPs were analysed using a temporal PCA. Two P300 components, P3b and the Slow Wave, were found to linearly increase in amplitude to longer TTIs. This TTI effect differed between groups only for the P3b component: The high WM group showed a steeper increase in P3b amplitude with TTI than the low WM group. These results suggest that TTI effects in P300 are directly related to WM processes.

Can event-related potentials serve as neural markers for wins, losses, and near-wins in a gambling task? A principal components analysis.

Originally, the feedback related negativity (FRN) event-related potential (ERP) component was considered to be a robust neural correlate of non-reward/punishment processing, with greater negative deflections observed following unfavourable outcomes. More recently, it has been suggested that this component is better conceptualised as a positive deflection following rewarding outcomes. The current study sought to elucidate the nature of the FRN, as well as another component associated with incentive-value processing, the P3b, through application of a spatiotemporal principal components analysis (PCA). Seventeen healthy controls played a computer electronic gaming machine (EGM) task and received feedback on credits won or lost on each trial, and ERPs were recorded. The distribution of reward/non-reward outcomes closely matched that of a real EGM, with frequent losses, and infrequent wins and near-wins. The PCA revealed that feedback elicited both a frontally maximal negative deflection to losses, and a positive deflection to wins (which was also sensitive to reward magnitude), implying that the neural generator/s of the FRN are differentially activated following these outcomes. As expected, greater P3b amplitudes were found for wins compared to losses. Interestingly, near-wins elicited significantly smaller FRN amplitudes than losses (with no differences in P3b amplitude), and may contribute to the maintenance of gambling behaviours on EGMs. The results of the current study are integrated into a response profile of healthy controls to outcomes of varying incentive value. This may provide a foundation for the future examination of individuals who exhibit abnormalities in reward/punishment processing, such as problem gamblers.