Handbook of Mentalizing in Mental Health Practice

We conducted a comprehensive meta-analysis of the Level of Service (LS) scales, their predictive accuracy and group-based differences in risk/need, across 128 studies comprising 151 independent samples and a total of 137,931 offenders. Important potential moderators were examined including ethnicity, gender, LS scale variant, geographic region, and type of recidivism used to measure outcome. Results supported the predictive accuracy of the LS scales and their criminogenic need domains for general and violent recidivism overall, and among broad subgroups of interest, including females and ethnic minorities. Although results indicated that gender and ethnicity were not substantive sources of effect size variability, significant differences in effect size magnitude were found when analyses were conducted by geographic region. Canadian samples consistently demonstrated the largest effect sizes, followed by studies conducted outside North America, and then studies conducted in the United States. This pattern was observed irrespective of gender, ethnicity, LS domain, LS variant, or type of recidivism outcome, suggesting geographic region may be an important source of effect size variation. We discuss possible factors underlying this pattern of results and identify areas for future research.

Thirty years of research on the level of service scales: a meta-analytic examination of predictive accuracy and sources of variability.

Background Routine outcome monitoring of common mental health disorders (CMHDs), using patient reported outcome measures (PROMs), has been promoted across primary care, psychological therapy and multidisciplinary mental health care settings, but is likely to be costly, given the high prevalence of CMHDs. There has been no systematic review of the use of PROMs in routine outcome monitoring of CMHDs across these three settings. Objectives To assess the effects of routine measurement and feedback of the results of PROMs during the management of CMHDs in 1) improving the outcome of CMHDs; and 2) in changing the management of CMHDs. Search methods We searched the Cochrane Depression Anxiety and Neurosis group specialised controlled trials register (CCDANCTR-Studies and CCDANCTR-References), the Oxford University PROMS Bibliography (2002-5), Ovid PsycINFO, Web of Science, The Cochrane Library, and International trial registries, initially to 30 May 2014, and updated to 18 May 2015. Selection criteria We selected cluster and individually randomised controlled trials (RCTs) including participants with CMHDs aged 18 years and over, in which the results of PROMs were fed back to treating clinicians, or both clinicians and patients. We excluded RCTs in child and adolescent treatment settings, and those in which more than 10% of participants had diagnoses of eating disorders, psychoses, substance use disorders, learning disorders or dementia. Data collection and analysis At least two authors independently identified eligible trials, assessed trial quality, and extracted data. We conducted meta-analysis across studies, pooling outcome measures which were sufficiently similar to each other to justify pooling. Main results We included 17 studies involving 8787 participants: nine in multidisciplinary mental health care, six in psychological therapy settings, and two in primary care. Pooling of outcome data to provide a summary estimate of effect across studies was possible only for those studies using the compound Outcome Questionnaire (OQ-45) or Outcome Rating System (ORS) PROMs, which were all conducted in multidisciplinary mental health care or psychological therapy settings, because both primary care studies identified used single symptom outcome measures, which were not directly comparable to the OQ-45 or ORS.Meta-analysis of 12 studies including 3696 participants using these PROMs found no evidence of a difference in outcome in terms of symptoms, between feedback and no-feedback groups (standardised mean difference (SMD) -0.07, 95% confidence interval (CI) -0.16 to 0.01; P value = 0.10). The evidence for this comparison was graded as low quality however, as all included studies were considered at high risk of bias, in most cases due to inadequate blinding of assessors and significant attrition at follow-up.Quality of life was reported in only two studies, social functioning in one, and costs in none. Information on adverse events (thoughts of self-harm or suicide) was collected in one study, but differences between arms were not reported.It was not possible to pool data on changes in drug treatment or referrals as only two studies reported these. Meta-analysis of seven studies including 2608 participants found no evidence of a difference in management of CMHDs between feedback and no-feedback groups, in terms of the number of treatment sessions received (mean difference (MD) -0.02 sessions, 95% CI -0.42 to 0.39; P value = 0.93). However, the evidence for this comparison was also graded as low quality. Authors' conclusions We found insufficient evidence to support the use of routine outcome monitoring using PROMs in the treatment of CMHDs, in terms of improving patient outcomes or in improving management. The findings are subject to considerable uncertainty however, due to the high risk of bias in the large majority of trials meeting the inclusion criteria, which means further research is very likely to have an important impact on the estimate of effect and is likely to change the estimate. More research of better quality is therefore required, particularly in primary care where most CMHDs are treated.Future research should address issues of blinding of assessors and attrition, and measure a range of relevant symptom outcomes, as well as possible harmful effects of monitoring, health-related quality of life, social functioning, and costs. Studies should include people treated with drugs as well as psychological therapies, and should follow them up for longer than six months.

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Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults.

Forgiveness Therapy : An Empirical Guide for Resolving Anger and Restoring Hope

Single-case experimental designs. Evaluating interventions in research and clinical practice.

This study entails the use of meta-analytic techniques to calculate and analyze 18 independent and 52 nonindependent effect sizes across 17 published studies of psychological assessment as a therapeutic intervention. In this sample of studies, which involves 1,496 participants, a significant overall Cohen's d effect size of 0.423 (95% CI [0.321, 0.525]) was found, whereby 66% of treatment group means fell above the control and comparison group means. When categorical variables were taken into account, significant treatment group effects were found for therapy process variables (d = 1.117, [0.679, 1.555]), therapy outcomes (d = 0.367, [0.256, 0.478]), and combined process/outcome variables (d = 0.547, [0.193, 0.901]). These findings appear to be robust on the basis of fail-safe N calculations. Taken together, they suggest that psychological assessment procedures-when combined with personalized, collaborative, and highly involving test feedback-have positive, clinically meaningful effects on treatment, especially regarding treatment processes. They also have important implications for assessment practice, training, and policy making, as well as future research, which are discussed in the conclusion of the article.

Meta-analysis of psychological assessment as a therapeutic intervention.

Building Confidence in Psychological Assessment as a Therapeutic Intervention: An Empirically Based Reply to Lilienfeld, Garb, and Wood (2011).

The relationship between episodic and dispositional forgiveness and the resolution of Erikson's (1963) psychosocial crises were explored in this study. Participants (N = 66) completed the Enright Forgiveness Inventory (Enright & Rique, 2004), Tendency to Forgive Scale (Brown, 2003), and Measures of Psychosocial Development (Hawley, 1988). Results are consistent with forgiveness and Eriksonian theories. Episodic forgiveness and dispositional forgiveness accounted for 8% and 10%, respectively, of the variance in global resolution of psychosocial crises. The most pronounced relationship was between both forgiveness types and Erikson's crises related to basic trust and ego integrity. Implications for counseling research, practice, and training are discussed.

The Relationship Between Episodic and Dispositional Forgiveness, Psychosocial Development, and Counseling

Research on breaking bad news has involved undergraduates, medical students, and physicians However, to date, no studies have examined how, or whether, psychologists are trained to break bad news, as well as their current practice of breaking bad news This mixed methods study explored the training and practice of 329 licensed psychologists/APA members in breaking bad news, using the MUM effect as a theoretical backdrop Results suggest (1) psychologists are, as hypothesized, significantly more reluctant to break bad news than good news, (2) anxiety accounts for 306% of the variance in their reluctance, and (3) three-out-of-four psychologists break bad news “to some extent” or more, most typically related to a patient’s psychological health, major Axis I diagnosis, or learning disability Results also suggest most psychologists are not trained to break bad news, with only 27% being familiar with existing recommendations and guidelines; and anxiety, concerns for self/other, context, and norms play an important role in the bad news breaking process Implications for theory, research, and practice are discussed and a training model is proposed

National survey of psychologists' training and practice in breaking bad news: a mixed methods study of the MUM effect.

Not just anything goes: Psychoanalytic psychotherapy competencies in psychology doctoral programs.

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