Renewed Feedback-Informed Group Treatment for Patients with Anxiety and Depressive Disorders.

Feedback-Informed Group Treatment (FIGT) shows promise for improving outcomes, but results are mixed. The aim was investigating the feasibility, acceptability and effects of renewed FIGT on clinical outcomes and therapy processes. In a quasi-experimental pilot study, 65 patients with anxiety or depressive disorders and 15 therapists of interpersonal psychotherapy or cognitive behavioural therapy groups using renewed FIGT were included. Renewed FIGT contained three additions compared to the previous tool: (1) personalized goals along with the Outcome Questionnaire-45 (OQ-45), (2) therapists' training, coaching and intervision, and (3) instructions to actively use feedback in the group. Data on feasibility, acceptability, outcomes and process factors were analysed and compared with those of historical cohorts using only OQ-45 feedback or no feedback, using descriptive, multilevel and covariance statistical analyses. Feasibility was mostly improved, with patients experiencing more feedback discussions and better usability compared to only OQ-45 feedback. At least two thirds of the patients and therapists give preference to using feedback in the future. At the end of the study, therapists were less convinced that the OQ-45 and goals were able to detect change. Renewed FIGT did not improve effectiveness on clinical outcomes. Compared to no feedback, patients experienced more cohesion, engagement and less avoidance, but improved less on depressive symptoms. Even when renewed FIGT is more feasible and usable than only OQ-45 feedback and associated with more cohesiveness and engagement, it may not automatically lead to improved effectiveness on clinical outcomes in short-term group therapy. Implications and future directions are described.

The effect of imagery rescripting on core beliefs and eating disorder symptoms in a subclinical population.

BACKGROUND AND OBJECTIVES: This study compared the effect of imagery rescripting focusing on self-compassion, imagery rescripting focusing on mastery, and a positive memory control condition on (1) emotional responses towards the memory (one day after), (2) changes in the believability of negative core beliefs, and dysfunctional eating behaviors (one week after) in individual at risk for developing an eating disorder. METHODS: Female participants (N = 69) were allocated to one of three conditions: ImRs focusing on self-compassion (N = 24), ImRs focusing on self-mastery (N = 23), and positive memory control condition (N = 22). Participants in the ImRs conditions received a 20-min self-guided ImRs intervention, whereas participants in the control condition received a 20-min self-guided task focusing on an unrelated positive memory. RESULTS: The experimental manipulation successfully induced the use of self-compassion and mastery strategies in the respective imagery rescripting condition. However, our data show that a single 20-min session of self-guided imagery rescripting focusing on compassion and/or mastery has no effect on the emotional response towards the aversive memory or in the change of core beliefs and eating behaviors at follow up. LIMITATIONS: We discuss potential reasons for the null findings, including the use of a single imagery rescripting session, the sample size and the measurement of manipulation checks. CONCLUSION: Future studies are needed to rule out methodological explanations for the null results. These findings may be of value for the development of future experimental lab paradigms which aim to evaluate the causal effects and working mechanisms of imagery rescripting.

The feasibility, acceptability and effectiveness of a feedback-informed group treatment (FIGT) tool for patients with anxiety or depressive disorders.

Monitoring treatment progress by the use of standardized measures in individual therapy, also called feedback-informed treatment (FIT), has a small but significant effect on improving outcomes. Results of FIT in group therapy settings are mixed, possibly due to contextual factors. The goals of this study were to investigate the feasibility, acceptability and effectiveness of a feedback-informed group treatment (FIGT) tool, based on the principles of the Contextual Feedback Theory and earlier FIGT research. Patients with anxiety or depressive disorders following interpersonal or cognitive behavioural group psychotherapy (IPT-G or CBT-G) were randomized to either feedback (n=104) or Treatment As Usual (TAU; n=93). In the feedback condition, patients filled out the Outcome-Questionnaire 45 (OQ-45) weekly in a FIGT tool and therapists were instructed to discuss the results in each session. Dropout, attendance and outcomes were measured. Additionally, in the feedback condition, OQ-45 response, feedback discussions and acceptability by patients and therapists were assessed. Results showed no differences on dropout, but lower attendance rates in the feedback condition. Although therapists reported high rates of feedback use and helpfulness, patients experienced that results were discussed with them only half of the time and they were also less optimistic about its usefulness. The findings indicate that the FIGT instrument was partially feasible, more acceptable to therapists than patients, and was not effective as intended. Future research is needed to discover how feedback can be beneficial for both therapists and patients in group therapy.

On the use of positive test strategies when diagnosing mental disorders.

BACKGROUND: Despite the adverse impact diagnostic errors can have, clinical interviewing and decision-making in psychiatric practice have received relatively little empirical attention. When diagnosing patients, clinicians tend to fall back on a specific (heuristic) rule of thumb, the positive test strategy, a confirmatory approach that increases the risk of confirmation bias. METHOD AND RESULTS: A group of 83 clinical psychologists and psychiatrists was asked to give their diagnostic hypotheses about two vignettes. We found them to self-generate significantly (i.e., p < .01; d = 1.57) more confirming than disconfirming questions to test their initial diagnostic impressions, with supervisors considering significantly more differential diagnoses than the less experienced post-grads/residents. When offered a list of 100 potentially relevant diagnostic queries, the supervisors selected fewer confirming and proportionally more disconfirming themes. CONCLUSIONS: Our results demonstrate that irrespective of clinical experience mental-health clinicians indeed tend to use a confirmatory thinking style that contrasts with the stricter principle of falsification. More field-based research on this topic is needed, as well as studies probing whether a systematized diagnostic approach is feasible in psychiatric practice and increases diagnostic accuracy and patient satisfaction.

Feedback-informed Group Treatment: A Qualitative Study of the Experiences and Needs of Patients and Therapists.

Therapists, including group therapists, can systematically gather feedback from patients about how their group members are responding to treatment. However, results of research on using feedback-informed group treatment (FIGT) are mixed, and the underlying mechanisms responsible for positive patient changes remain unclear. Therefore, the present qualitative study examined the perceptions and experiences of both (a) group therapists and (b) group members regarding using feedback in their therapy groups to gauge treatment progress, across five different therapy groups. Specifically, three interpersonal psychotherapy groups and two cognitive-behavioral therapy groups used a FIGT tool in which treatment progress updates were provided to patients and therapists. Observational data were collected in the form of feedback discussions in these therapy groups, as well as during interviews conducted with patients and therapists. Data were analyzed using thematic analysis and a grounded theory approach. Overall, patients were mostly positive about their experiences with FIGT, but therapists also expressed concerns about FIGT. Results indicated that FIGT is useful for gaining insight and strengthening the working alliance. In addition, specific group processes were also found to be important, especially interpersonal learning, cohesion, and social comparison. Practical implications are discussed.

PACT: A protocol for assessment, mechanism-based case formulation and treatment planning.

BACKGROUND: Proponents of clinical case formulations argue that the causes and mechanisms contributing to and maintaining a patient's problems should be analysed and integrated into a case conceptualization, on which treatment planning ought to be based. Empirical evidence shows that an individualized treatment based on a case formulation is at least sometimes better than a standardized evidence-based treatment. METHODS: We argue that it is likely to improve decisions when two conditions hold: (a) knowing about the mechanisms underlying the patient's problems makes a difference for treatment, and (b) the case formulation is based on valid knowledge about mechanisms of psychopathology. RESULTS: We propose a protocol for assessment, case formulation and treatment planning (PACT), which incorporates transdiagnostic accounts of psychopathology. PACT describes a 5-step decision making process, which aims to help clinicians to decide when to resort to evidence-based treatments and when to construct a case formulation to individualize the treatment. CONCLUSION: We show how PACT works in practice by discussing treatment planning for a clinical case involving symptoms of social anxiety, depression and post-traumatic stress disorder.

Firearm examination: Examiner judgments and computer-based comparisons.

Forensic firearm examination provides the court of law with information about the source of fired cartridge cases. We assessed the validity of source decisions of a computer-based method and of 73 firearm examiners who compared breechface and firing pin impressions of 48 comparison sets. We also compared the computer-based method's comparison scores with the examiners' degree-of-support judgments and assessed the validity of the latter. The true-positive rate (sensitivity) and true-negative rate (specificity) of the computer-based method (for the comparison of both the breechface and firing pin impressions) were 94.4% and at least 91.7%, respectively. For the examiners, the true-positive rate was at least 95.3% and the true-negative rate was at least 86.2%. The validity of the source decisions improved when the evaluations of breechface and firing pin impressions were combined and for the examiners also when the perceived difficulty of the comparison decreased. The examiners were reluctant to provide source decisions for "difficult" comparisons even though their source decisions were mostly correct. The correlation between the computer-based method's comparison scores and the examiners' degree-of-support judgments was low for the same-source comparisons to negligible for the different-source comparisons. Combining the outcomes of computer-based methods with the judgments of examiners could increase the validity of firearm examinations. The examiners' numerical degree-of-support judgments for their source decisions were not well-calibrated and showed clear signs of overconfidence. We suggest studying the merits of performance feedback to calibrate these judgments.

Assessing deictic relational responding in psychosis using the implicit relational assessment procedure

The current study sought to investigate perspective-taking in a group of individuals diagnosed with psychosis. The Psychosis Implicit Relational Assessment Procedure (Psychosis-IRAP) contrasted statements and questions referring to 'psychotic' and 'non-psychotic' experiences. The IRAP and a Faux-pas (Theory of Mind) test were presented to two groups of participants: a clinical group with a diagnosis of psychosis and a control group. IRAP effects for each group were in the predicted direction and a ROC analysis showed that the IRAP correctly classified 80% of the individuals with psychosis with a sensitivity level of 84.2% and a specificity level of 27.8%. The IRAP was thus successfully used to correctly classify the population of clinical individuals. However, the study also demonstrated that the two groups were similar with regard to their level of competency on the perspective-taking IRAP. The article also discusses the relationship between the data and recent developments in RFT, in terms of relational flexibility

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Assessing deictic relational responding in social anxiety using the implicit relational assessment procedure

The current study sought to investigate perspective-taking in a group of individuals diagnosed with psychosis. The Social Anxiety Implicit Relational Assessment Procedure (SA-IRAP) contrasted statements and questions referring to 'anxious' and 'non-anxious' experiences. The SA-IRAP and a Faux-pas (Theory of Mind) test were presented to two groups of participants: a clinical group with a diagnosis of social anxiety and a group of controls. IRAP effects for each group were in the predicted direction and a ROC analysis showed that the IRAP correctly classified 77% of the individuals with social anxiety with a sensitivity level of 97% and a specificity level of 36%. The IRAP was thus successfully used to correctly classify the sample of clinical individuals. However, the study also demonstrated that the two groups were similar with regard to their level of competency on the perspective-taking IRAP. The article also discusses the relationship between the data and recent developments in RFT

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Cognitive biases in the peer review of bullet and cartridge case comparison casework: A field study.

OBJECTIVE: Forensic judgments and their peer review are often the result of human assessment and are thus subjective and prone to bias. This study examined whether bias affects forensic peer review. HYPOTHESES: We hypothesized that the probability of disagreement between two forensic examiners about the proposed conclusion would be higher with "blind" peer review (reviewer saw only the first examiner's comparison photos) than with "non-blind" peer review (reviewer also saw the first examiner's interpretation and proposed conclusion). We also hypothesized that examiners with a higher perceived professional status would have a larger effect on the reported conclusion than examiners with a lower status. METHOD: We acquired data during a non-blind and a blind peer review procedure in a naturalistic, covert study with eight examiners (3-26 years of experience). We acquired 97 conclusions of bullet and cartridge case comparisons in the blind and 471 in the non-blind peer review procedure. RESULTS: The odds of disagreement between examiners about the evidential strength of a comparison were approximately five times larger (95%-CI [3.06, 8.50]) in the blind than in the non-blind procedure, with disagreement about 42.3% and 12.5% of the proposed conclusions, respectively. Also, the odds that their proposed conclusion was reported as the final conclusion were approximately 2.5 higher for the higher-status examiners than for lower-status examiners. CONCLUSIONS: Our results support both the hypothesis that bias occurs during non-blind forensic peer review and the hypothesis that higher-status examiners determine the outcome of a discussion more than lower-status examiners. We conclude that blind peer review may reduce the probability of bias and that status effects have an impact on the peer reviewing process.

Assessing the frequency of general fingerprint patterns by fingerprint examiners and novices.

The rarity of general fingerprint patterns should be taken into account in the assessment of fingerprint evidence to provide a more complete assessment of fingerprint evidence than when only considering the minutiae. This should be done because, the rarer the corresponding pattern, the stronger the support for the hypothesis that the fingermark stems from the same source as the reference fingerprint. Fingerprint examiners' experience should enable them to provide meaningful assessments of the frequencies of these general patterns according to the theories of perceptual learning, exemplar theory of categorization and visual statistical learning. In this study we examined the accuracy of fingerprint examiners' and novices' judgments on the rarity of general fingerprint patterns. We found that fingerprint examiners seem to have acquired some knowledge about the rarity of general patterns, but had difficulty expressing this knowledge quantitatively using a novel sub-classification of general patterns. As a consequence, their judgments were not accurate and they did not perform better on this task than novices. For both participant groups judgments of more common patterns were more accurate. However, examiners did outperform novices in rank ordering general patterns from common to rare. We conclude that our study does not show that fingerprint examiners have expertise in explicitly judging frequencies of novel sub-classifications of general fingerprint patterns, but our results do indicate that the examiners have acquired knowledge about the rarity of patterns that novices do not possess.

Art activities and qigong exercise for the well-being of older adults in nursing homes in Indonesia: a randomized controlled trial.

Objective: This study aims to investigate the effect of an integrated intervention of art activities and Qigong exercise on the well-being of older adults in nursing homes in Indonesia.Method: We employed a randomized controlled trial with 4 specific groups, i.e. art, Qigong, integration of art and Qigong, and control group. A total of 267 participants aged 50 years or older were recruited from 9 nursing homes in Jakarta, Indonesia. The participants were randomly allocated to one of the four groups, attending two intervention sessions per week for eight weeks (16 sessions), lasting 90 minutes each. Measurements were administered at baseline (T0) and post-intervention (T1). The primary outcome was well-being (WHOQOL-Bref) and secondary outcomes were satisfaction with life (SWLS), depression (BDI-II), and health status (SF-36).Results: The art intervention had a significant positive effect on well-being, in particular in the domain of social relations. It also led to a decrease in depressive symptoms, as did the integration intervention. No significant effects were visible in the Qigong group nor in the integrated intervention compared to either art or Qigong alone.Conclusion: Interventions such as art programs and an integration of art and Qigong may give psychological benefits to older adults. Yet, results of the study need to be interpreted with caution and need to be replicated. A qualitative approach would be welcome to get an in-depth understanding of why art intervention is especially beneficial. (Trial registration: Clinicaltrials.gov NCT02957773, registered 28 September 2016).

Validity and reliability of forensic firearm examiners.

Forensic firearm examiners compare the features in cartridge cases to provide a judgment addressing the question about their source: do they originate from one and the same or from two different firearms? In this article, the validity and reliability of these judgments is studied and compared to the outcomes of a computer-based method. The features we looked at were the striation patterns of the firing pin aperture shear marks of four hundred test shots from two hundred Glock pistols, which were compared by a computer-based method. Sixty of the resulting 79,800 comparisons were shown to 77 firearm examiners. They were asked to judge whether the cartridge cases had the same source or a different source, and to indicate the degree of support the evidence provided for those judgments. The results show that the true positive rates (sensitivity) and the true negative rates (specificity) of firearm examiners are quite high. The examiners seem to be slightly less proficient at identifying same-source comparisons correctly, while they outperform the used computer-based method at identifying different-source comparisons. The judged degrees of support by examiners who report likelihood ratios are not well-calibrated. The examiners are overconfident, giving judgments of evidential strength that are too high. The judgments of the examiners and the outcomes of the computer-based method are only moderately correlated. We suggest to implement performance feedback to reduce overconfidence, to improve the calibration of degree of support judgments, and to study the possibility of combining the judgments of examiners and the outcomes of computer-based methods to increase the overall validity.

The Effectiveness of Combining Visual Art Activities and Physical Exercise for Older Adults on Well-Being or Quality of Life and Mood: A Scoping Review.

Visual art activities and physical exercise are both low-intensity and low-cost interventions. The present study aims to comprehensively describe published literature on the effectiveness of a combination of these interventions on well-being or quality of life (QoL) and mood of older adults. Embase, CINAHL, Ovid Medline (R), PsycINFO, and Web of Science databases were searched for studies published between 1990 and 2015 that evaluated interventions combining visual art therapy and exercise for people aged 50 years or older with at least one resultant well-being or QoL or mood outcome. We found 10 studies utilizing different combination programs and outcome measures, and most had small sample sizes. Seventy percent of the studies reported that combining both interventions was effective in improving well-being or QoL and mood in older adults. Future studies are, however, requisite to investigate whether in the respective population such a combination is more effective than either of the interventions alone.

All's Bad That Ends Bad: There Is a Peak-End Memory Bias in Anxiety.

The peak-end memory bias has been well documented for the retrospective evaluation of pain. It describes that the retrospective evaluation of pain is largely based on the discomfort experienced at the most intense point (peak) and at the end of the episode. This is notable because it means that longer episodes with a better ending can be remembered as less aversive than shorter ones; this is even if the former had the same peak in painfulness and an overall longer duration of pain. Until now, this bias has not been studied in the domain of anxiety despite the high relevance of variable levels of anxiety in the treatment of anxiety disorders. Therefore, we set out to replicate the original studies but with an induction of variable levels of anxiety. Of 64 women, half watched a clip from a horror movie which ended at the most frightening moment. The other half watched an extended version of this clip with a moderately frightening ending. Afterward, all participants were asked to rate the global anxiety which was elicited by the video. When the film ended at the most frightening moment, participants retrospectively reported more anxiety than participants who watched the extended version. This is the first study to document that the peak-end bias can be found in the domain of anxiety. These findings require replication and extension to a treatment context to evaluate its implications for exposure therapy.

Characteristics and content of intrusive images in patients with eating disorders.

The aim of this study was to examine the characteristics and content of intrusive images in patients with different subtypes of eating disorders (EDs). Data were collected from 74 ED patients, 22 dieting, and 29 nondieting controls. Participants completed a set of self-report questionnaires. Intrusive images of ED patients were significantly more repetitive, detailed, vivid, and distressing than intrusive images of dieting and/or nondieting controls. Most of the intrusive images were the same for the ED subtypes; however, patients with anorexia nervosa were more likely to report an observer vantage perspective than patients with bulimia nervosa, who were more likely to report a field vantage perspective. As expected, intrusive images' content was related to body checking (weight and shape) or negative self (evaluated by themselves or others). Finally, there were significant associations between intrusive images' vividness and weight and shape concerns. These findings indicate that intrusive images may be a core element of EDs and targeting intrusive images in therapy may be helpful.

Reasons for placement decisions in a case of suspected child abuse: The role of reasoning, work experience and attitudes in decision-making.

Child welfare and child protection workers regularly make placement decisions in child abuse cases, but how they reach these decisions is not well understood. This study focuses on workers' rationales. The aim was to investigate the kinds of arguments provided in placement decisions and whether these arguments were predictors for the decision, in addition to the decision-makers' risk assessment, work experience and attitudes towards placement. The sample consisted of 214 professionals and 381 students from the Netherlands. The participants were presented with a vignette describing a case of alleged child abuse and were asked to determine whether the abuse was substantiated, to assess risks and to recommend an intervention. The participants' placement attitudes were assessed using a structured questionnaire. We found that the participants provided a wide range of arguments, but that core arguments - such as the suspected abuse, parenting and parent-child interaction - were often missing. Regression analyses showed that the higher the perceived danger to the child and the more positive the participants' attitudes towards placement, the more likely the participants would be to propose placing the child in care. Arguments related to the severity of the problems (i.e., suspected abuse, parenting and the child's development) as well as the parents' perceived cooperation also influenced placement decisions. The findings indicate trends in the decision-making process, in the sense that participants who decided to place the child out-of-home emphasized different arguments and had different attitudes towards out-of-home placement than those who did not. We discuss the implications of our findings.

The impact of vaccination and patient characteristics on influenza vaccination uptake of elderly people: A discrete choice experiment.

OBJECTIVES: To improve information for patients and to facilitate a vaccination coverage that is in line with the EU and World Health Organization goals, we aimed to quantify how vaccination and patient characteristics impact on influenza vaccination uptake of elderly people. METHODS: An online discrete choice experiment (DCE) was conducted among 1261 representatives of the Dutch general population aged 60 years or older. In the DCE, we used influenza vaccination scenarios based on five vaccination characteristics: effectiveness, risk of severe side effects, risk of mild side effects, protection duration, and absorption time. A heteroscedastic multinomial logit model was used, taking scale and preference heterogeneity (based on 19 patient characteristics) into account. RESULTS: Vaccination and patient characteristics both contributed to explain influenza vaccination uptake. Assuming a base case respondent and a realistic vaccination scenario, the predicted uptake was 58%. One-way changes in vaccination characteristics and patient characteristics changed this uptake from 46% up to 61% and from 37% up to 95%, respectively. The strongest impact on vaccination uptake was whether the patient had been vaccinated last year, whether s/he had experienced vaccination side effects, and the patient's general attitude towards vaccination. CONCLUSIONS: Although vaccination characteristics proved to influence influenza vaccination uptake, certain patient characteristics had an even higher impact on influenza vaccination uptake. Policy makers and general practitioners can use these insights to improve their communication plans and information regarding influenza vaccination for individuals aged 60 years or older. For instance, physicians should focus more on patients who had experienced side effects due to vaccination in the past, and policy makers should tailor the standard information folder to patients who had been vaccinated last year and to patient who had not.

Parentification, Stress, and Problem Behavior of Adolescents who have a Parent with Mental Health Problems.

When adolescents live with a parent with mental illness, they often partly take over the parental role. Little is known about the consequences of this so-called parentification on the adolescents' internalizing and externalizing problems. This survey study examined this effect cross-sectionally and longitudinally in a sample of 118 adolescents living with a parent suffering from mental health problems. In addition, the study examined a possible indirect effect via perceived stress. Path analyses were used to examine the direct associations between parentification and problem behavior as well as the indirect relations via perceived stress. The results showed that parentification was associated with both internalizing and externalizing problems cross-sectionally, but it predicted only internalizing problems 1 year later. An indirect effect of parentification on adolescent internalizing and externalizing problems via perceived stress was found, albeit only cross-sectionally. These findings imply that parentification can be stressful for adolescents who live with a parent with mental health problems, and that a greater awareness of parentification is needed to prevent adolescents from developing internalizing problems.

Sex Bias in Classifying Borderline and Narcissistic Personality Disorder.

This study investigated sex bias in the classification of borderline and narcissistic personality disorders. A sample of psychologists in training for a post-master degree (N = 180) read brief case histories (male or female version) and made DSM classification. To differentiate sex bias due to sex stereotyping or to base rate variation, we used different case histories, respectively: (1) non-ambiguous case histories with enough criteria of either borderline or narcissistic personality disorder to meet the threshold for classification, and (2) an ambiguous case with subthreshold features of both borderline and narcissistic personality disorder. Results showed significant differences due to sex of the patient in the ambiguous condition. Thus, when the diagnosis is not straightforward, as in the case of mixed subthreshold features, sex bias is present and is influenced by base-rate variation. These findings emphasize the need for caution in classifying personality disorders, especially borderline or narcissistic traits.