Psychotherapy Outcome Research: Issues and Questions.

Emphasis on identifying evidence-based therapies (EBTs) has increased markedly. Lists of EBTs are the rationale for recommendations for how psychotherapy provider training programs should be evaluated, professional competence assessed, and licensure and reimbursement policies structured. There are however methodological concerns that limit the external validity of EBTs.

Empirically Based Psychosocial Therapies for Schizophrenia: The Disconnection between Science and Practice.

Empirically validated psychosocial therapies for individuals diagnosed with schizophrenia were described in the report of the Schizophrenia Patient Outcomes Research Team (PORT, 2009). The PORT team identified eight psychosocial treatments: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. PORT listings of empirically validated psychosocial therapies provide a useful template for the design of effective recovery-oriented mental health care systems.

Controversies in psychotherapy research: epistemic differences in assumptions about human psychology.

It is the thesis of this paper that differences in philosophical assumptions about the subject matter and treatment methods of psychotherapy have contributed to disagreements about the external validity of empirically supported therapies (ESTs). These differences are evident in the theories that are the basis for both the design and interpretation of recent psychotherapy efficacy studies. The natural science model, as applied to psychotherapy outcome research, transforms the constitutive features of the study subject in a reciprocal manner so that problems, treatments, and indicators of effectiveness are limited to what can be directly observed.

Some limitations on the external validity of psychotherapy efficacy studies and suggestions for future research.

Increased emphasis on identifying empirically supported treatments (ESTs) has enhanced the scientific basis for psychotherapy practice, but uncritical acceptance of ESTs as the basis for credentialing and policy decisions risks stifling innovation and creativity in the field. There are limitations inherent in efficacy studies of psychotherapy that can constrain external validity. This article discusses several limitations on the external validity of efficacy studies, as well as other issues related to evaluating psychotherapy outcome research.

Magical ideation, schizotypy and the impact of emotions.

Research indicates that emotions can interfere with basic cognitive functions such as attention and memory, and that schizotypal traits may be related to vulnerability to such interference, The schizotypal trait magical ideation, expressed as illogicality and tendencies to endorse peculiar or eccentric beliefs, has been reported to be related to impairments in social cognitive functioning as well risk for psychosis. This study examined the impact of emotionally arousing films on heart rate activity, affect ratings, and working memory. Participants were university students.

Evidence-based psychosocial practices and recovery from schizophrenia.

Pessimistic views about the course and outcome of schizophrenia have been replaced by a more hopeful perspective that emphasizes on providing opportunities for recovery. Recovery, from a provider perspective, means that priority is placed on providing access to treatments and community services that have been proven effective in both decreasing symptoms and assisting individuals to lead maximally productive and personally meaningful lives. In 2004, the Schizophrenia Patient Outcomes Research Team (PORT) published a consensus list of evidence-based practices (EBPs) that includes six psychosocial treatments.

Symptoms of schizophrenia and social cognition.

This study investigated the relationship between deficits in social cognition and the dimensional descriptors for schizophrenia. Social cognitive functioning was measured using patient narratives describing card arrangements using the picture arrangement subtest of the Weschler Adult Intelligence Scale-Revised. Stories were rated for number of normative themes, number of words, coherence, plausibility of attributions of emotions, and plausibility of attributions of intentions.

Sensitivity and specificity of depression questionnaires in a college-age sample.

The authors evaluated the sensitivity and specificity of the Beck Depression Inventory-II (BDI-II; A. T. Beck, R.

A taxometric study of the Center for Epidemiological Studies Depression Scale.

The authors assessed the latent structure of depressive symptoms as measured by the Center for Epidemiological Studies Depression Scale (CES-D; L. S. Radloff, 1977).

Recent developments in psychosocial treatments for schizophrenic patients.

Pessimistic views regarding the course and outcome of schizophrenia have been replaced by an emphasis on recovery. The concept of recovery emphasizes the need to provide access to treatments and services that are effective in both decreasing manifestations of the disorder and in assisting individuals to lead maximally productive and personally meaningful lives. To this end, the schizophrenia Patient Outcomes Research Team (PORT) published an updated consensus list of evidence-based practices that includes 14 recommendations, six of which describe psychosocial treatments (family interventions, supported employment, assertive community treatment, skills training, cognitive therapy and token economy programs).

Recognition of nonverbal affect and schizotypy.

The authors assessed the degree to which schizotypal characteristics in a nonclinical population were associated with impairments in the ability to correctly identify emotions as expressed in facial, paralinguistic, and postural cues. Participants completed the Schizotypal Personality Questionnaire (SPQ; A. Raine, 2005), and the 3 receptive subtests of the Diagnostic Analysis of Nonverbal Accuracy-2 (DANVA2; S.

Social-cognitive functioning and schizotypal characteristics.

The authors examined the relationship between social cognition and a feature of schizotypal personality referred to as magical ideation, defined broadly as the presence and intensity of illogical beliefs about causality and the nature of reality. The measures of social cognition used in this study were the Character Intention Task (CIT) and the adult version of the Reading the Mind in the Eyes Test. Regression analyses indicated that understanding of character intentions, as measured by CIT scores, and ability to identify emotions on the Eyes test were related to non-realistic beliefs.

Social cognition and symptom dimensions.

This study used the Picture Arrangement subtest of the Wechsler Adult Intelligence Scale to assess social cognitive functioning of psychotic patients diagnosed with bipolar, schizophrenia, or schizoaffective disorder. All participants were rated on positive and negative symptom rating scales, from which three symptom dimensions were obtained. Symptom dimensions were not significantly related to ratings of symptom severity or mental status examination scores.

Shifts in diagnostic frequencies during the years 1975-1999.

Data on discharge diagnoses was obtained from a state-supported mental hospital located in the mid-Atlantic region of the United States for the years 1975 through 1999. Results indicated that frequencies of diagnosis of major mental disorders changed significantly during this interval, with reciprocal changes between schizoaffective and affective disorders and schizophrenia. Percentages of total discharge diagnoses of major affective disorders increased threefold, diagnoses of schizoaffective disorders increased fivefold, and schizophrenia diagnoses decreased threefold during the interval of study.

Is cognitive therapy consistent with what we know about emotions?

The cognitive perspective has been a dominant force in psychology and psychotherapy since the 1970s. Cognitive therapies share an emphasis on the priority of changing cognition as the key to bringing about changes in patterns of dysfunctional emotional reactions and symptomatic behaviors. In this article, the author examined the basis for the assumptions of cognitive therapy in the context of recent evidence of the long-term effects of stressful experiences.

Interpersonal aspects of the syndromes of schizophrenia.

Raters listened to interviews with schizophrenic patients and rated each participant using Wiggins's Interpersonal Adjective Checklist-Revised, a measure of interpersonal behavior. It was predicted that three symptom dimensions (disorganization, psychoticism and negative symptoms) would be associated with unique patterns of interpersonal behavior. Results indicated that symptoms of psychoticism (systematized delusions and auditory hallucinations) were rated as evidencing Arrogant-Calculating characteristics.

Symptoms of schizophrenia and neurocognitive test performance.

Schizophrenic in-patients were rated on factor-derived symptom dimensions based on negative and positive symptom ratings. Participants were administered neuropsychological tests (digit span, digit vigilance, logical memory, and Trails A and B) and then instructed on how to improve performance on the tests. Follow-up tests were administered shortly after coaching.

A critical look at the assumptions of cognitive therapy.

The cognitive perspective has been a dominant force in psychology and psychotherapy since the 1970s. Cognitive therapists assume that changing cognition is the key to bringing about changes in emotional reactions and symptomatic behaviors. This article examines evidence that is not consistent with the assumptions of cognitive therapy.

Impairment in test performance and symptom dimensions of schizophrenia.

Schizophrenic patients were rated on three syndromal dimensions derived from positive and negative symptom ratings. Scores on each dimension were compared to performance on neuropsychological tests before and after coaching instructions. Patients evidenced significant improvement in performance on all measures readministered immediately after instruction.

Clinical depression and day-to-day social interaction in a community sample.

Adult participants recruited from the community, one half of whom met criteria for clinical depression, described their day-to-day social interactions using a variant of the Rochester Interaction Record. Compared with the nondepressed participants, depressed participants found their interactions to be less enjoyable and less intimate, and they felt less influence over their interactions. Differences between the two groups in intimacy occurred only in interactions with close relations and not in interactions with nonintimates, and differences in influence were more pronounced for those who were cohabiting than for those who were not.

Depressed and nondepressed students: differences in interpersonal perceptions.

The purpose of this research was to study the patterns of interpersonal behavior of depressed students. Depressed participants rated themselves lower than non-depressed controls on assertiveness and initiation of interactions and significantly higher than controls on concern about what others think, introversion, and submissiveness. Depressed participants also scored significantly higher than controls on measures of dependency, self-criticism, and the need to please others.

Syndromes of schizophrenia and language dysfunction.

This study investigated the relationship between performance on word association and sentence construction tasks and the three-syndrome model of schizophrenic symptoms. Participants were 70 inpatients with a primary diagnosis of schizophrenia. Each participant was rated on positive and negative symptom scales, and ratings were grouped into three syndromal patterns (Reality Distortion, Psychomotor Poverty, and Disorganization).

The effects of anxiety sensitivity and history of panic on reactions to stressors in a non-clinical sample.

This study attempted to determine the effects of physical and mental stressors on a non-clinical population that varied in terms of history of panic attacks and level of anxiety sensitivity. Groups included: (1) individuals with a history of panic attacks, (2) those with high scores on the anxiety sensitivity index and no history of panic and (3) those with no panic experiences and low anxiety sensitivity. Results indicated that participants with a history of panic and those with high anxiety sensitivity reported significantly higher levels of anxiety ratings, bodily symptoms, and anxious thoughts than low anxiety sensitivity subjects during a balloon inflation task.