A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes

© 2019 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (March 2019) in accordance with the publisher’s archiving policyBackground and objectives Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion). Methods Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported. Results The intervention led to significant decreases in symptoms of OCD (d = −0.9; CI: -1.4, −0.4) and eating disorders (d = −0.6; CI: -1.0, −0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = −0.9; CI: -1.4, −0.4), and fear of self-compassion (d = −0.8; CI: -1.3, −0.3). At follow-up changes were maintained in symptoms of OCD (d = −1.3; CI: -1.8, −0.8), disordered eating (d = −0.7; CI: -1.2, −0.2), intolerance of uncertainty (d = −0.8; CI: -1.2, −0.3), and fear of self-compassion (d = −1.0; CI: -1.5, −0.5). Conclusions Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871

A Virtual Reprise of the Stanley Milgram Obedience Experiments

BACKGROUND: Stanley Milgram's 1960s experimental findings that people would administer apparently lethal electric shocks to a stranger at the behest of an authority figure remain critical for understanding obedience. Yet, due to the ethical controversy that his experiments ignited, it is nowadays impossible to carry out direct experimental studies in this area. In the study reported in this paper, we have used a similar paradigm to the one used by Milgram within an immersive virtual environment. Our objective has not been the study of obedience in itself, but of the extent to which participants would respond to such an extreme social situation as if it were real in spite of their knowledge that no real events were taking place. METHODOLOGY: Following the style of the original experiments, the participants were invited to administer a series of word association memory tests to the (female) virtual human representing the stranger. When she gave an incorrect answer, the participants were instructed to administer an ‘electric shock’ to her, increasing the voltage each time. She responded with increasing discomfort and protests, eventually demanding termination of the experiment. Of the 34 participants, 23 saw and heard the virtual human, and 11 communicated with her only through a text interface. CONCLUSIONS: Our results show that in spite of the fact that all participants knew for sure that neither the stranger nor the shocks were real, the participants who saw and heard her tended to respond to the situation at the subjective, behavioural and physiological levels as if it were real. This result reopens the door to direct empirical studies of obedience and related extreme social situations, an area of research that is otherwise not open to experimental study for ethical reasons, through the employment of virtual environments

The partner relationship in psychological response to breast cancer

The social support literature has demonstrated that interpersonal relationships play an important role in adaptation to serious illness. However, researchers have recently emphasized the limitations of the social support construct and have urged a focus of attention away from global measures of perceived support and towards specific processes that occur in close relationships. The present study examined the role of one such process--informal helping from the partner--in women's psychological response to breast cancer. Structured interviews were conducted with 113 women who had received a diagnosis of breast cancer within the previous year. We found that satisfaction with the partner helping relationship was associated with psychological well-being. Even though most women had a good helping relationship with another person, this did not compensate for a problematic helping relationship with the partner. Good communication with the partner was characterized by high empathy and low withdrawal. The findings suggest that the partner plays an important role in breast cancer patients' adaptation, and that interventions aimed at couples may be an effective way of reducing psychological distress.cancer social support informal helping couples

Research methods in clinical psychology : an introduction for students and practitioners, 2nd ed./ Barker

xv, p. 284; 23 c

Research methods in clinical psychology : an introduction for students and practitioners, 2nd ed./ Barker

xv, p. 284; 23 c

Non-clinicians’ judgments about asylum seekers’ mental health: how do legal representatives of asylum seekers decide when to request medico-legal reports?

Background : Procedures for determining refugee status across Europe are being speeded up, despite the high prevalence of mental health difficulties among asylum seekers. An assurance given is that ‘‘vulnerable applicants’’ will be identified and excluded from accelerated procedures. Although experts have recommended assessments to be undertaken by experienced clinicians, this is unlikely to happen for political and financial reasons. Understanding how non-clinically qualified personnel perform assessments of mental health issues is timely and crucial. Misrecognition of refugees due to the inappropriate use of accelerated procedures involves the risk of returning the very people who have the right to protection from further persecution. Objective : To examine the decision making of immigration lawyers, who are an example of a group of nonclinicians who decide when and whether to refer asylum-seekers for psychiatric assessment. Method : Semi-structured interviews were conducted with 12 legal representatives working with people seeking refugee or human rights protection in the United Kingdom. The resultant material was analysed using Framework Analysis. Results : Themes clustered around the legal case, the client, the representative and the systems, all with sub-themes. A mapping exercise integrated these themes to show how representatives brought together questions of (1) evidential reasons for a report, influenced by their legal, psychological and case law knowledge, and (2) perceived evidence of mental distress, influenced by professional and personal experiences and expectations. Conclusions : The legal representatives interviewed were well-informed and trained in psychological issues as well as clearly dedicated to their clients. This helped them to attempt quasi-diagnoses of common mental health problems. They nonetheless demonstrated stereotypical understanding of post-traumatic stress disorder and other possible diagnoses and the role of subjectivity. The study has implications for other groups – particularly those less trained and compassionate – who are required to make clinical judgments without the necessary expertise

Secular and Spiritual "Myths" of Mindfulness-Based Programs: the Effects of Role Inductions on a Brief Mindfulness-Based Intervention

OBJECTIVES: Mindfulness meditation has both spiritual and secular foundations. Drawing on Jerome Frank’s concept of a healing “myth,” this study investigated the relative influence of spiritual and secular inductions to a brief mindfulness-based intervention. We hypothesized that, compared to narrower spiritual or secular presentations, an integrated role induction to mindfulness meditation would be more effective at improving the perceived credibility of, and expectations regarding, this practice, and hence would result in a subsequent mindfulness practice having a greater effect on state mindfulness and affect. We also hypothesized that there would be congruency effects between participants’ dispositional spirituality/secularity and their assigned induction group. METHODS: Participants (n = 179) were randomly allocated to one of three role inductions (spiritual, secular, or integrated); all then received the same brief, online, mindfulness intervention. Dispositional measures of secularity and spirituality were taken at baseline, and state measures of credibility and expectations, mindfulness and affect were taken at baseline, post-induction, and post-intervention. RESULTS: Following attrition and screening for participation, data from 124 completers were analyzed. Participants improved across time on measures of credibility and expectations, state mindfulness, and negative affect. Contrary to the hypotheses, the integrated induction group did not improve more than the secular or spiritual groups, nor were congruency effects found. However, there was significantly less participant attrition in the integrated group than the other two conditions. CONCLUSIONS: It is argued that a more broadly accessible “myth” may help more participants to persevere with mindfulness practice

Facilitating understanding of mental health problems in GP consultations: a qualitative study using taped-assisted recall

BackgroundMental health problems are common in primary care and most are managed solely by the GP. Patients strive to understand their mental health problems, and facilitating patients' understanding may be important in their care, yet little is known about this process in GP consultations.AimTo explore how patients' understanding of common mental health problems is developed in GP consultations.Design of studyQualitative study.SettingTen general practices in North Central London.MethodFourteen patients and their GPs were interviewed using the taped-assisted recall (TAR) method, and asked how understanding of the patients' mental health problems had been discussed in a recent consultation. The resulting 42 transcripts of the GP patient consultations and separate GP and patient TAR interviews were analysed using qualitative thematic and process analytic methods.ResultsPatients considered understanding their mental health problems to be important, and half reported their GP consultations as helpful in this respect. The process of coming to an understanding was predominantly patient-led. Patients suggested their own explanations, and these were facilitated and focused by the doctors' questioning, listening, validating, and elaborating aspects they considered important. Both doctors and patients experienced constraints on the extent to which developing understanding of problems was possible in GP consultations.ConclusionGPs can help patients understand their mental health problems by recognising patients' own attempts at explanation and helping to shape and develop these