The Chanka: Archaeological Research in Andahuaylas (Apurimac), Peru

In AD 1438 a battle took place outside the city of Cuzco that changed the course of South American history. The Chanka, a powerful ethnic group from the Andahuaylas region, had begun an aggressive program of expansion. Conquering a host of smaller polities, their army had advanced well inside the territory of their traditional rival, the Inca. In a series of unusual maneuvers, the Inca defeated the invading Chanka forces and became the most powerful people in the Andes. Many scholars believe that the defeat of the Chanka represents a defining moment in the history of South America as the Inca then continued to expand and establish the largest empire of the Americas. Despite its critical position in South American history, until recently the Chanka heartland remained unexplored and the cultural processes that led to their rapid development and subsequent defeat by the Inca had not been investigated. From 2001 to 2004, Brian Bauer conducted an archaeological survey of the Andahuaylas region. This project represents an unparalleled opportunity to examine theoretical issues concerning the history and cultural development of late-prehistoric societies in this area of the Andes. The resulting book includes an archaeological analysis on the development of the Chanka and examines their ultimate defeat by the Inca. Series: Monographs 6

Transdiagnostic CBT treatment of co-morbid anxiety and depression in an older adult: Single case experimental design

Background: Despite the prevalence of co-morbid anxiety and depression in older adults, evaluation of suitable clinical models is rare. Aims: This study tested the acceptability and effectiveness of a transdiagnostic approach to treating co-morbid anxiety and depression in an older adults in a routine clinical setting. Method: In an A/B single case experimental design, a patient completed five daily ideographic measures of anxiety and depression across baseline and treatment and the HADS at five time points over time, including 3-month follow-up. The 8-session treatment was transdiagnostic CBT informed by the Unified Protocol. Results: All sessions were attended. Significant baseline-treatment improvements were found for daily structure, mood, confidence and worry, with large associated effect sizes. The HADS showed that the patient met recovery criteria by the end of treatment, with some evidence of anxious relapse at follow-up. Conclusion: Transdiagnostic CBT offers promise as a treatment approach to mixed anxiety and depression in older adults. The model needs to be further tested using more rigorous and suitably powered methodologies

When Feeling Mixed Can Be Meaningful: The Relation Between Mixed Emotions and Eudaimonic Well-Being

Whilst positive emotions benefit well-being, the role of other more complex emotional experiences for well-being is less well understood. This research therefore investigated the relationship between mixed emotions and eudaimonic well-being. A cross-sectional study (Study 1; N = 429) first demonstrated (using structural equation modelling) that mixed emotions are related to the presence of goal conflict. Importantly, it was also found that mixed emotions are positively related to eudaimonic well-being, and that one potential mechanism linking mixed emotions and eudaimonic well-being is via the search for meaning in life. Study 2 (N = 52) implemented a quasi-experiment regarding a naturally occurring meaningful life event (i.e., graduation day) and again demonstrated that mixed emotions are associated with a greater level of eudaimonic well-being. Implications of these findings include the importance of mixed emotions in the search for meaning in life, and the role of mixed emotions in goal conflict resolution

Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults

Objectives: There is a dearth of older adult evidence regarding the group treatment for co-morbid anxiety and depression. This research evaluated the effectiveness of a low-intensity group psychoeducational approach. Method: Patients attended six sessions of a manualised cognitive-behavioural group. Validated measures of anxiety, depression and psychological well-being were taken at assessment, termination and six-week follow-up from patients, who also rated the alliance and their anxiety/depression at each group session. Staff rated patients regarding their functioning at assessment, termination and six-week follow-up. Outcomes were categorised according to whether patients had recovered, improved, deteriorated or been harmed. Effect sizes were compared to extant group interventions for anxiety and depression. Results: Eight groups were completed with 34 patients, with a drop-out rate of 17%. Staff and patient rated outcome measures showed significant improvements (with small effect sizes) in assessment to termination and assessment to follow-up comparisons. Over one quarter (26.47%) of patients met the recovery criteria at follow-up and no patients were harmed. Outcomes for anxiety were better than for depression with the alliance in groups stable over time. Conclusion: The intervention evaluated shows clinical and organisational promise. The group approach needs to be further developed and tested in research with greater methodological control

The effectiveness of cognitive analytic therapy for borderline personality disorder : utilizing a withdrawal experimental design to improve sensitivity to abandonment

Objectives A primary methodological weakness of the single‐case experimental design (SCED) outcome studies conducted of the treatment of personality disorder with cognitive analytic therapy (CAT) is that they have failed to employ a withdrawal phase or cross‐over design and so are deemed quasi‐experimental. This study sought to implement a withdrawal design, in order to improve the internal validity of the study to make it a true SCED, and also in order to enable the patient to explore abandonment dynamics. Design The study employed an A1/B1/A2/B2 with extended follow‐up SCED with a female patient treated with CAT meeting diagnostic criteria for borderline personality disorder (BPD). Following the 6‐week baseline period ‘A1’, treatment occurred in two phases (21 sessions ‘B1’ and 24 sessions ‘B2’) sandwiching a 12‐week treatment withdrawal phase (‘A2’) and a 24‐week structured follow‐up phase. Seven idiographic daily measures were collected that created a N = 698 day timeline. Nomothetic outcome measures were collected at baseline and at the end of each phase of the study, and the Session Impact Scale was completed after each treatment session. Results There was a significant increase in the task focus of treatment sessions. Ideographically, CAT was an effective treatment for improving the participant’s self‐to‐self relationship, as their self‐hate reduced and their sense‐of‐self increased. There was a broad pattern of deterioration during the second treatment phase (B2) and follow‐up phase across the ideographic measures, and CAT was ineffective for BPD ideographic emotional or self‐to‐other measures. Reliable change occurred on the primary BPD nomothetic outcome measure from baseline to end of first treatment phase. Conclusions The study suggests that the CAT intervention was partially successful and that it is possible to integrate good research practice with clinical innovation. The methodological strengths and limitations of the design and the clinical implications of the results are discussed. Practitioner points Cognitive analytic therapy was partially effective in the treatment of BPD in a case that had been unresponsive to other psychological interventions. Therapists need to complete lengthy and structured follow‐up to capture any emerging relapse. Therapists need to discuss the patient’s thoughts and feelings about termination regularly in a relationally informed manner

Predicting return to work from health related welfare following low intensity cognitive behaviour therapy

The aim of this study was to identify predictors of return to work in the short and long term following condition management cognitive-behavioural therapy (CM-CBT). All participants (N = 3794) were disability welfare claimants, unemployed due to the presence of a physical or mental health condition. CM-CBT consisted of a seven session group cognitive-behavioural psychoeducational programme, with participants followed-up at 3 and 12-30 months. The primary employment outcome measure was a categorical measure of either returned to work, made progress towards work or remained on welfare. Results index an incremental progress and return to work rate, increasing from 34.41 % at short-term follow-up to 53.07 % at long-term follow-up. Clinically, 17.40 % were classed as recovered following CM-CBT. Reliable psychological change during CM-CBT predicted successful return to work and remaining on welfare was associated with psychological regression over time. The results are discussed in terms of identified methodological weaknesses and the potential of CBT in enabling return to work for the health related unemployed

Prevalence of hoarding disorder: A systematic review and meta-analysis

Currently there is uncertainty concerning the prevalence of Hoarding Disorder (HD) due to methodological issues in the evidence base. Estimates have widely ranged from between 1.5% and 6% of the general population. This systematic review and meta-analysis therefore aimed to summarise and reliably estimate the prevalence of HD by employing strict inclusion criteria and using studies with sufficiently large samples. A systematic literature search was conducted to identify all relevant prevalence studies. Inclusion criteria were studies that reported working age adult HD prevalence rates and had sample sizes of at least 1009 participants. Eleven studies met criteria (n = 53,378), had low risk of bias and were originally based in developed countries. A random effects meta-analysis was then conducted, with subgroup moderator analysis and meta-regression. The pooled estimated prevalence for HD was 2.5% (CI 1.7–3.6%) and subgroup analyses revealed that prevalence rates were similar for both males and females. Guidance on the manner in which HD is assessed in future prevalence studies is provided and the clinical implications of the results discussed

Exploring emotions and cognitions in hoarding: a Q-methodology analysis

Background: The cognitions and emotions of people prone to hoarding are key components of the dominant cognitive behavioural model of hoarding disorder. Aims: This study sought to use Q-methodology to explore the thoughts and feelings of people that are prone to hoarding, to identify whether distinct clusters of participants could be found. Method: A 49-statement Q-set was generated following thematic analysis of initial interviews (n = 2) and a review of relevant measures and literature. Forty-one participants with problematic hoarding met various study inclusion criteria and completed the Q-sort (either online or offline). A by-person factor analysis was conducted and subsequent participant clusters compared on psychometric measures of mood, anxiety, hoarding and time taken on the online task as proxy for impulsivity. Results: Four distinct participant clusters were found constituting 34/41 (82.92%) of the participants, as the Q-sorts of n = 7 participants failed to cluster. The four clusters found were ‘overwhelmed’ (n = 11 participants); ‘aware of consequences’ (n = 13 participants); ‘object complexity’ (n = 6 participants) and ‘object–affect fusion’ (n = 4 participants). The clusters did not markedly differ with regard to hoarding severity, anxiety, depression or impulsivity. Conclusions: Whilst the participant clusters reflect extant research evidence, they also reveal significant heterogeneity and so prompt the need for further research investigating emotional and cognitive differences between people prone to hoarding