An explanatory sequential investigation of the working alliance as a change process in videoconferencing psychotherapy.

OBJECTIVES AND DESIGN: Debate exists as to patient experience, and the importance, of the working alliance (WA) in videoconferencing psychotherapy (VCP). This study used a two-phase explanatory sequential design to investigate the WA as a change process in VCP. METHODS: Phase I: sessional VCP outcome and WA data were analysed using multilevel modelling (n = 46). Phase II: participants (n = 12) from Phase I were recruited to semi-structured interviews, analysed using thematic framework analysis. RESULTS AND CONCLUSIONS: Results demonstrate: (1) a significant correlation between WA and outcome (F(1, 15.19) = 25.01, p < 0.001), (2) previous session WA significantly predicted outcome in the next session (F(1, 355.61) = 4.47, p < 0.05), and (3) previous session outcome significantly predicted next session WA (F(1, 55.3) = 15.19, p < 0.001), with three core themes explaining patient experience (engaging with the medium, connection with the therapist, and working via the medium). Results are discussed and future research recommended.

Limited Etching Time Increases Self-adhesive Resin Cement Adhesion to Enamel.

AIM: To evaluate the influence of different enamel etching times on the bond strength of two self-adhesive resin cements (RCs) with and without thermocycling (TMC). METHODS: One hundred twenty bovine teeth were used. Blocks of enamel (8×4×2mm) were obtained, polished, and randomly divided into two groups, according to the RC used: MaxCem Elite or RelyX U200. Groups were subdivided into four groups (n=16), according to the etching time: Control (0 seconds), 5 seconds, 10 seconds, and 20 seconds. Three RC cylinders (1-mm diameter) were built on each enamel block. The specimens were submitted to two storage conditions: 24 hours in distilled water or TMC (5000 cycles/5°C-55°C). Afterward, the specimens were submitted to the shear bond strength (SBS) test. The failure modes and adhesive interfaces were analyzed by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Data were analyzed with three-way analysis of variance (ANOVA) and Tukey test (α=0.05). RESULTS: Etching increased the SBS for both the RCs,especially forthe groups etched for 5 and 10 seconds. TMC affected negatively the SBS of the control groups (p<0.05). No resin tags were observed in control groups, and the formation of tags was time dependent. CONCLUSION: The 10 seconds etching time was more effective in increasing the enamel-resin bond strength. TMC negatively affected bond strength in specimens without acid etching.

Influence of Multiple Peak Light-emitting-diode Curing Unit Beam Homogenization Tips on Microhardness of Resin Composites.

This study evaluated the effect of light curing unit (LCU) guide type (regular or homogenizing) on top and bottom microhardness of conventional and bulk-fill resin-based composites (RBCs). A polywave light-emitting-diode (LED) LCU (Bluephase Style, Ivoclar Vivadent AG) was used with two different light guides: a regular tip (RT, 935 mW/cm2 emittance) and a homogenizer tip (HT, 851 mW/cm2 emittance). Two conventional RBCs (Herculite Ultra [HER], Kerr Corp; Tetric EvoCeram [TEC], Ivoclar Vivadent AG) and two bulk-fill RBCs (SonicFill [SOF], Kerr Corp; Tetric EvoCeram Bulk Fill [TBF], Ivoclar Vivadent AG) were tested. Disc-shaped samples (10 mm Ø), 2-mm thick for conventional composites and 4-mm thick for bulk-fill composites were prepared. Samples were light cured according to manufacturer-recommended times. Knoop microhardness values (KHN) were obtained on the top and bottom surfaces of each specimen at locations correlated with the output of the three LED chips emitting blue (456 nm) or violet light (409 nm). Beam profile analysis using both light guides was also performed. Microhardness of each composite was analyzed using three-way analysis of variance and Tukey honestly significant difference post hoc test (α=0.05). Beam profile images showed better light distribution across the surface of the HT light guide. Use of the HT decreased KHN of HER at the locations of the blue LED chips at bottom of the sample but had no effect on the top surface. For TEC, use of HT increased KHN of all three LED locations at the top surface. Use of the HT increased KHN of SOF at locations corresponding to one of the blue and the violet LED chips at the bottom surface. For TBF, HT increased KHN at all top surface locations. All RBCs showed higher mean KHN at the top compared with the bottom surfaces. In general, all composites presented a higher KHN at the blue LED areas regardless of the surface or the tip used. Results suggest that the homogenizer light guide resulted in significantly increased microhardness at the top, in composite resins containing alternative photoinitiators; however, that effect was not observed at the bottom surfaces.

Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta-analysis.

Videoconferencing psychotherapy (VCP)-the remote delivery of psychotherapy via secure video link-is an innovative way of delivering psychotherapy, which has the potential to overcome many of the regularly cited barriers to accessing psychological treatment. However, some debate exists as to whether an adequate working alliance can be formed between therapist and client, when therapy is delivered through such a medium. The presented article is a systematic literature review and two meta-analyses aimed at answering the questions: Is working alliance actually poorer in VCP? And is outcome equivalence possible between VCP and face-to-face delivery? Twelve studies were identified which met inclusion/exclusion criteria, all of which demonstrated good working alliance and outcome for VCP. Meta-analyses showed that working alliance in VCP was inferior to face-to-face delivery (standardized mean difference [SMD] = -0.30; 95% confidence interval [CI] [-0.67, 0.07], p = 0.11; with the lower bound of the CI extending beyond the noninferiority margin [-0.50]), but that target symptom reduction was noninferior (SMD = -0.03; 95% CI [-0.45, 0.40], p = 0.90; CI within the noninferiority margin [0.50]). These results are discussed and directions for future research recommended.

Stability of the Light Output, Oral Cavity Tip Accessibility in Posterior Region and Emission Spectrum of Light-Curing Units.

OBJECTIVES: This study evaluated the light output from six light-emitting diode dental curing lights after 25 consecutive light exposures without recharging the battery, tip accessibility in the posterior region, and light beam spread from light-curing units. METHODS: Irradiance, spectral peak, and radiant exposure were measured with the battery fully charged (Bluephase Style, ESPE Cordless, Elipar S10, Demi Ultra, Valo Cordless, and Radii-Cal) and monitored for 25 light exposures (each lasting 10 seconds). The tip diameter was measured to identify the beam size and the ability of the six light-curing units to irradiate all areas of the lower second molar in the standard output setting. RESULTS: Four curing lights delivered a single peak wavelength from 454 to 462 nm, and two (Bluephase Style and Valo Cordless) delivered multiple emission peaks (at 410 and 458 nm and 400, 450, and 460 nm, respectively). The irradiance and radiant exposure always decreased after 25 exposures by 2% to 8%, depending on the light unit; however, only ESPE Cordless, Valo Cordless, and Radii-Cal presented a statistical difference between the first and the last exposure. The tip diameter ranged from 6.77 mm to 9.40 mm. The Radii-Cal delivered the lowest radiant exposure and irradiance. This light was also unable to access all the teeth with the tip parallel to the occlusal surface of the tooth. CONCLUSION: Not all of the blue-emitting lights deliver the same emission spectra, and some curing lights delivered a lower irradiance (as much as 8% lower) after the 25th exposure.

A systematic review of team formulation in clinical psychology practice: Definition, implementation, and outcomes.

PURPOSE: Team formulation is promoted by professional practice guidelines for clinical psychologists. However, it is unclear whether team formulation is understood/implemented in consistent ways - or whether there is outcome evidence to support the promotion of this practice. This systematic review aimed to (1) synthesize how team formulation practice is defined and implemented by practitioner psychologists and (2) analyse the range of team formulation outcomes in the peer-reviewed literature. METHODS: Seven electronic bibliographic databases were searched in June 2016. Eleven articles met inclusion criteria and were quality assessed. Extracted data were synthesized using content analysis. RESULTS: Descriptions of team formulation revealed three main forms of instantiation: (1) a structured, consultation approach; (2) semi-structured, reflective practice meetings; and (3) unstructured/informal sharing of ideas through routine interactions. Outcome evidence linked team formulation to a range of outcomes for staff teams and service users, including some negative outcomes. Quality appraisal identified significant issues with evaluation methods; such that, overall, outcomes were not well-supported. CONCLUSIONS: There is weak evidence to support the claimed beneficial outcomes of team formulation in practice. There is a need for greater specification and standardization of 'team formulation' practices, to enable a clearer understanding of any relationships with outcomes and implications for best-practice implementations. PRACTITIONER POINTS: Under the umbrella term of 'team formulation', three types of practice are reported: (1) highly structured consultation; (2) reflective practice meetings; and (3) informal sharing of ideas. Outcomes linked to team formulation, including some negative outcomes, were not well evidenced. Research using robust study designs is required to investigate the process and outcomes of team formulation practice.

How do differential explanations of voice-hearing influence attributions and behavioral intentions towards voice-hearers?

Explanations regarding the etiology of mental health difficulties have been found to affect public attitudes towards those who experience such difficulties. Utilizing a large, randomized parallel-groups design (N=1004), we examined how standardized differential explanations of voice-hearing influence public attitudes, attributions, and behavioral intentions towards voice-hearers. Additionally, we incorporated a behavioral outcome measure to examine whether reported behavioral intentions towards voice-hearers were related to responses towards an individual with a history of voice-hearing. Consistent with attribution theory, mediated pathways between attributions and intentions were identified: broadly, viewing the voice-hearer's behavior as dangerous, within their personal responsibility, and global was associated with more coercive intentions - and these were mediated by feelings of fear, anger, and pity. Reported behavioral intentions demonstrated small-to-moderate associations with our behavioral outcome measure. The findings suggest that explanations regarding the etiology of mental health difficulties that seek to reduce public attributions of dangerousness, personal responsibility, and globality may facilitate more helpful responses towards voice-hearers.

The impact of receiving a diagnosis of Non-Epileptic Attack Disorder (NEAD): A systematic review.

BACKGROUND: Clinicians have reported observations of the immediate cessation of non-epileptic attacks after the diagnosis of NEAD is presented. OBJECTIVE: The purpose of this systematic review was to examine the impact of receiving a diagnosis of NEAD. SEARCH STRATEGY: A literature search across the databases Medline, PsycINFO, EMBASE, and CINAHL, and additional hand searching, identified six original studies meeting criteria for the review. SELECTION CRITERIA: Included studies were original peer-reviewed articles investigating the impact of receiving a diagnosis of NEAD on adult populations with at least one outcome measured pre- and post-diagnosis. ANALYSIS: The studies were assessed for methodological quality, including biases. This assessment was developed to include criteria specific to research regarding NEAD and diagnosis. RESULTS: Six identified studies, with a total of 153 NEAD participants, examined the impact of receiving a diagnosis on seizure frequency. Two of the six also examined the impact on health-related quality of life. The findings were inconsistent, with approximately half the participants experiencing seizure reduction or cessation post-diagnosis. Diagnosis appeared to have no significant impact on health-related quality of life. The overall evidence lacked quality, particularly in study design and statistical rigour. CONCLUSIONS: Mixed results and a lack of high quality evidence were found. Concerns are considered regarding the appropriateness of seizure frequency as the primary outcome measure and the use of epilepsy control groups. Indications for future research include: measuring more meaningful outcomes, using larger samples and power calculations, and ensuring consistent and standard methods for communicating the diagnosis and recording outcomes.

Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures.

PURPOSE: Self-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE. METHODS: Thirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State-Trait Anxiety Inventory and Patient Health Questionnaire-15 (a somatic symptom inventory) were also administered. RESULTS: We found significant group differences in explicit (p<0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit-explicit SE discrepancies were larger in the group with PNESs than in the other groups (p<0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (rs=-.83, p<0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; rs=.65, p<0.01). These relationships remained significant when controlling for anxiety and somatization. CONCLUSION: Patients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit-implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE.

Anxiety and avoidance in psychogenic nonepileptic seizures: the role of implicit and explicit anxiety.

This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p<.001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r=.63, p<.01) and frequency of seizures (r=.67, p<.01); implicit anxiety correlated with frequency of seizures only (r=.56, p<.01). Our findings demonstrate the role of implicit anxiety in PNESs and provide additional support for the contribution of explicit anxiety and experiential avoidance to this disorder.

Parental bonding and eating disorders: a systematic review.

This article systematically reviewed studies of parental bonding in people with eating disorders. MEDLINE, PsychINFO, EMBASE and CINAHL were searched to identify studies that compared parental bonding in people diagnosed with an eating disorder relative to non-clinical controls. Twenty-four studies were identified. Women with eating disorders typically reported lower parental care and higher parental protection compared to non-clinical, but not psychiatric, controls. Interestingly, a modest number of studies found that these relationships were mediated by avoidant problem solving style and several schemas from the Young Schema Questionnaire (YSQ; Schmidt, Joiner, Young, & Telch, 1995). While there are methodological limitations associated with the reviewed studies, they do offer some support for the proposal that difficulties in parent-child relationships predispose women to eating disorders and other psychiatric diagnoses.

Smoking, mood regulation, and personality: an event-sampling exploration of potential models and moderation.

The aim of the present study was to test potential models of smoking-related changes in mood and how these are moderated by personality (behavioral activation and inhibition systems). Three models yielding distinct predictions regarding mood changes associated with cues to smoking and effects of ingestion were identified: the negative reinforcement model, the appetitive-incentive model, and the incentive-sensitization model. Seventy participants provided baseline data on personality and mood, and subsequently monitored their smoking behavior over 48 hours using an event-contingent diary--eliciting reports of mood state immediately prior to, and after, each cigarette smoked. MANOVA and multilevel modeling indicated that mood (hedonic tone and energetic arousal) improved significantly (p<.001) from baseline to pre-smoking, but did not change from pre- to post-smoking, thereby supporting the incentive-sensitization model. Further multilevel analyses indicated that significant variability in hedonic tone was moderated by the behavioral activation system.

Memory bias in health anxiety is related to the emotional valence of health-related words.

OBJECTIVES: A model based on the associative strength of object evaluations is tested to explain why those who score higher on health anxiety have a better memory for health-related words. METHOD: Sixty participants observed health and nonhealth words. A recognition memory task followed a free recall task and finally subjects provided evaluations (emotionality, imageability, and frequency) for all the words. Hit rates for health words, d', c, and psychological response times (PRTs) for evaluations were examined using multi-level modelling (MLM) and regression. RESULTS: Health words had a higher hit rate, which was greater for those with higher levels of health anxiety. The higher hit rate for health words is partly mediated by the extent to which health words are evaluated as emotionally unpleasant, and this was stronger for (moderated by) those with higher levels of health anxiety. Consistent with the associative strength model, those with higher levels of health anxiety demonstrated faster PRTs when making emotional evaluations of health words compared to nonhealth words, while those lower in health anxiety were slower to evaluate health words. CONCLUSIONS: Emotional evaluations speed the recognition of health words for high health anxious individuals. These findings are discussed with respect to the wider literature on cognitive processes in health anxiety, automatic processing, implicit attitudes, and emotions in decision making.