A randomised controlled trial of positive memory training for the treatment of depression within schizophrenia.

BACKGROUND: Depression is highly prevalent within individuals diagnosed with schizophrenia, and is associated with an increased risk of suicide. There are no current evidence based treatments for low mood within this group. The specific targeting of co-morbid conditions within complex mental health problems lends itself to the development of short-term structured interventions which are relatively easy to disseminate within health services. A brief cognitive intervention based on a competitive memory theory of depression, is being evaluated in terms of its effectiveness in reducing depression within this group. METHODS/DESIGN: This is a single blind, intention-to-treat, multi-site, randomized controlled trial comparing Positive Memory Training plus Treatment as Usual with Treatment as Usual alone. Participants will be recruited from two NHS Trusts in Southern England. In order to be eligible, participants must have a DSM-V diagnosis of schizophrenia or schizo-affective disorder and exhibit at least a mild level of depression. Following baseline assessment eligible participants will be randomly allocated to either the Positive Memory Training plus Treatment as Usual group or the Treatment as Usual group. Outcome will be assessed at the end of treatment (3-months) and at 6-month and 9-month post randomization by assessors blind to group allocation. The primary outcome will be levels of depression and secondary outcomes will be severity of psychotic symptoms and cost-effectiveness. Semi-structured interviews will be conducted with all participants who are allocated to the treatment group so as to explore the acceptability of the intervention. DISCUSSION: Cognitive behaviour therapy is recommended for individuals diagnosed with schizophrenia. However, the number of sessions and length of training required to deliver this intervention has caused a limit in availability. The current trial will evaluate a short-term structured protocol which targets a co-morbid condition often considered of primary importance by service users. If successful the intervention will be an important addition to current initiatives aimed at increasing access to psychological therapies for people diagnosed with severe mental health problems. TRIAL REGISTRATION: Current Controlled Trials. ISRCTN99485756 . Registered 13 March 2014.

A Qualitative Investigation of Therapists' Attitudes towards Research: Horses for Courses?

BACKGROUND: A large body of research has identified that many therapists do not use research to inform their practice, but few studies investigate the reasons behind this. AIMS: The current study seeks to understand what sources therapists use to inform their practice and why they are chosen. METHOD: Thirty-three interviews with psychological therapists in the UK were undertaken. These were transcribed and analysed using Interpretative Phenomenological Analysis. RESULTS: Two superordinate themes emerged. The former focused on the nature of evidence and the latter described why certain sources were used to make clinical decisions. When discussing evidence, participants felt that research studies, specifically Randomized Controlled Trials (RCTs), used unrepresentative samples. Therapists felt that research other than RCTs, particularly qualitative research, was important. Therapist specific factors were felt to be as, or more, important than the technique used to treat patients. When discussing the sources they used, therapists preferred to use their clinical experience or their patients' experience to make clinical decisions. Theoretical or practical information was preferred to empirical research. The presentation of information was felt to be important to encourage the implementation of research, and therapists also felt tools such as outcome measures and manuals were too rigid to be useful. Finally, patients' choice of treatment was felt to be important in treatment decisions. CONCLUSIONS: The views of therapists were heterogeneous, but this study highlighted some of the barriers to closing the gap between science and practice. This knowledge can be used to increase the translation of science into practice.

Perceptual Facilitators for and Barriers to Career Progression: A Qualitative Study With Female Early Stage Investigators in Health Sciences.

PURPOSE: Despite efforts to increase the representation of women in the national scientific workforce, results still lag. While women's representation in health-related sciences has increased substantially, women remain underrepresented in senior leadership roles. This study was conducted to elucidate influences at the individual, interpersonal, organizational, and societal levels that present as barriers to and facilitators for advancement in research careers for women, with the goal of promoting and retaining a more diverse leadership. METHOD: The authors conducted individual, 1-hour, in-depth, semistructured interviews with 15 female early stage investigators pursuing careers in health sciences research at a large minority-serving institution in Florida in 2018. Interview guides were designed by using a social ecological framework to understand the influence of multilevel systems. Employing a qualitative approach, drawing from a phenomenological orientation, 2 researchers independently coded transcripts and synthesized codes into broad themes. RESULTS: Barriers and facilitators were reported at all ecological levels explored. Illustrative quotations reflect the unequal distribution of familial responsibilities that compete with career advancement, family members' lack of understanding of the demands of a research career, the importance of female mentors, perceived differences in the roles and expectations of female and male faculty at institutions, and normative upheld values that influence early career progression. CONCLUSIONS: Achieving pervasive and sustained changes that move toward gender equity in research requires solutions that address multilevel, explicit and implicit influences on women's advancement in science. Suggestions include shifting familial and institutional norms, creating support systems for women with female mentors, and enforcing consistent policies regarding the roles and expectations of faculty. Findings shed light on the influence of gender on career progression by providing context for the experiences of women and underscore the importance of addressing pervasive societal and structural systems that maintain inequities hindering women's progress in the scientific workforce.

Gender and Ethnicity in Dating, Hanging Out, and Hooking Up: Sexual Scripts Among Hispanic and White Young Adults.

We examined the scripts associated with heterosexual Hispanic and White young adults' most recent initial sexual or romantic encounter using two samples of heterosexual undergraduates: 224 Hispanic students (49% female) and 316 White students (51% female). Scripts were identified for three types of encounters: dating, hanging out, and hooking up. The three scripts had more than half of their actions in common. Items such as get to know one another, feel aroused, and engage in physical contact were present across all scripts for all participant groups. As expected, traditional gender roles were present within all scripts, but more so for dates than for hangouts and hookups. Men reported a higher presence of traditional gender roles than women across scripts and put a higher priority on the goal of physical intimacy across all scripts. Dating was the most prevalent script for all young adults, contradicting contemporary claims that "dating is dead." In terms of ethnicity, a higher proportion of Hispanic than White young adults went on dates, and a higher proportion of White students went on hookups, implying that social and contextual variables are important in understanding young adults' intimate relationships.

Diagnostic overlap between acute stress disorder and PTSD in victims of violent crime.

OBJECTIVE: In a group of crime victims, the authors investigated overlap between acute stress disorder and posttraumatic stress disorder (PTSD) diagnoses and their relative ability to predict PTSD at 6 months. METHOD: A mixed-sex group of 157 victims of violent assault were interviewed within 1 month of the crime. At the 6-month follow-up, 87.9% were reinterviewed by telephone. RESULTS: At baseline the rate of acute stress disorder was 19.1%, the rate of PTSD was 21.0%, and the percentage agreement between them was 95.5%. The two diagnoses were equally effective predictors of PTSD 6 months later. CONCLUSIONS: The high level of overlap between acute stress disorder and PTSD calls into question whether, as presently formulated, they represent distinct diagnoses.

The gap between science and practice: how therapists make their clinical decisions.

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists' practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists' choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists' theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.

Are the NICE guidelines for Obsessive Compulsive Disorder being used in primary care?

This study aims to: 1) assess the proportion of General Practioners (GPs) who are aware of or who have read the National Institute for Health and Clinical Excellence (NICE; 2005a) guidelines for Obsessive Compulsive Disorder (OCD), 2) compare this with the proportion of other mental health disorders found by previous research and 3) establish the prevalence of OCD in primary care. Questionnaires were sent to all GPs (n = 795) and practice managers (n = 157) in Berkshire and Buckinghamshire, South East England. These contained 19 questions and took 5 min to complete. After the first set of responses, larger practices were visited and telephoned to encourage further responses. The response rates were 10.1% from GPs and 19.1% from practice managers. In all, 48.7% of the GPs were aware of the NICE guidelines for OCD and 30.3% reported that they had read them--higher than for Post-Traumatic Stress Disorder, but lower than for depression. Of registered patients, 0.2% were diagnosed with OCD, lower than the 1.1% found in epidemiological studies.

Investigating the use of NICE guidelines and IAPT services in the treatment of depression.

Background There is evidence that the National Institute for Health and Clinical Excellence (NICE) guidelines for mental health disorders are used to varying degrees in primary care. A lack of access to cognitive-behavioural therapy (CBT) has been found to be a barrier to their implementation. The Improving Access to Psychological Therapies (IAPT) initiative was created in 2007 to increase the availability of NICE-recommended psychological treatments for depression and anxiety disorders within the National Health Service in England. Aim This study aims to investigate whether general practitioners (GPs) who have access to IAPT services and use NICE guidelines are more likely to use NICE concordant treatments for depression than those who do not. Depression was chosen as it is the most common mental health problem facing primary care physicians. Method Questionnaires were sent to 830 GPs in southeast England and six GPs were interviewed. The response rate to the questionnaires was 27% (n = 222). Results Ninety-five per cent of GPs were aware of the NICE guidelines for depression, and 76% had read them. Concordance with the guidelines was significantly higher when GPs had access to a local IAPT service or had read the NICE guidelines. Conclusions The interviews revealed favourable views to IAPT services when used, although access to treatments was still a common barrier to the implementation of the NICE guidelines for depression.

Feminism and psychology: analysis of a half-century of research on women and gender.

Starting in the 1960s, feminists argued that the discipline of psychology had neglected the study of women and gender and misrepresented women in its research and theories. Feminists also posed many questions worthy of being addressed by psychological science. This call for research preceded the emergence of a new and influential body of research on gender and women that grew especially rapidly during the period of greatest feminist activism. The descriptions of this research presented in this article derive from searches of the journal articles cataloged by PsycINFO for 1960-2009. These explorations revealed (a) a concentration of studies in basic research areas investigating social behavior and individual dispositions and in many applied areas, (b) differing trajectories of research on prototypical topics, and (c) diverse theoretical orientations that authors have not typically labeled as feminist. The considerable dissemination of this research is evident in its dispersion beyond gender-specialty journals into a wide range of other journals, including psychology's core review and theory journals, as well as in its coverage in introductory psychology textbooks. In this formidable body of research, psychological science has reflected the profound changes in the status of women during the last half-century and addressed numerous questions that these changes have posed. Feminism served to catalyze this research area, which grew beyond the bounds of feminist psychology to incorporate a very large array of theories, methods, and topics.

Does PTSD occur in sentenced prison populations? A systematic literature review.

BACKGROUND: A systematic review of the literature on mental disorder in prisoners, published in 2002, made no mention of post-traumatic stress disorder (PTSD), but indicators from other studies suggest that a history of serious and chronic trauma is common among offenders. AIMS: To conduct a systematic review of the literature with the specific questions: does any epidemiological study of sentenced prisoners include data on prevalence of PTSD while in prison? If so, what is the prevalence in this group? METHOD: Literature databases EMBASE, Medline, PsychInfo, PILOTS and SIGLE were searched. The Journal of Traumatic Stress was searched manually. Preliminary screening was conducted by reading abstracts of hundreds of papers. Ten exclusion criteria were then applied to the screened selection. Reference sections of all accessed papers were searched for any further studies. RESULTS: One hundred and three potentially relevant papers were identified after preliminary screening. Four met all criteria for inclusion and suffered none of the exclusion criteria. PTSD rates ranged from 4% of the sample to 21%. Women were disproportionately affected. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: All four papers suggested that the prevalence of PTSD among sentenced prisoners is higher than that in the general population, as reported elsewhere. Overall the findings suggest a likely need for PTSD treatment services for sentenced prisoners.

Community interventions concerning homophobic violence and partner violence against lesbians.

SUMMARY Homophobic violence and same-sex domestic violence against lesbians are described in this paper based on survey research and hotline calls conducted by a community anti-violence project. A community survey of 229 lesbians indicated that during a one-year period, about fifteen percent had been the target of homophobic violence and twelve percent had been the victim of same-sex partner violence. Violence was defined as including assault with a weapon, physical assault, sexual assault, stalking, and property destruction. The prevalence study was contrasted with actual hotline calls from lesbians during a five-year period. Examples illustrate how interventions based on these findings were used to influence police response, victim services, and legislation.

A systematic review of single-session psychological interventions ('debriefing') following trauma.

BACKGROUND: Single-session psychological interventions such as psychological debriefing have become widely used following traumatic events. The evidence for their effectiveness has been widely debated. This review aimed to consider the evidence for the effectiveness of one-off early interventions within 1 month of a traumatic event. METHODS: A systematic review using the standard Cochrane Collaboration methodology. Literature searches of various databases were performed to identify randomised controlled trials. The methodological quality of the studies identified was determined using standard measures, and the results were pooled to consider the overall evidence for effectiveness. RESULTS: Eleven randomised controlled trials were found, all of individual or couple interventions. Three studies associated the intervention with a positive outcome, 6 demonstrated no difference in outcome between intervention and non-intervention groups and 2 showed some negative outcomes in the intervention group (these studies had the longest follow-up periods). The methodological quality of the studies varied widely, but was generally poor. This review suggests that early optimism for brief early psychological interventions including debriefing was misplaced and that it should not be advocated for routine use. There remains an urgent need for randomised controlled trials of group debriefing and other early interventions.

The impact of group membership on lesbians' physical appearance.

Abstract The impact of lesbian group membership upon physical appearance was examined among 81 young lesbians (ages 18-30) who participated in a questionnaire study. Most participants indicated making distinct but modest changes in their physical appearance after coming out as lesbians. These changes were in the direction of their pre-coming out conceptions of lesbians as being butch or androgynous in appearance. A majority reported cutting their hair shorter, wearing more comfortable shoes, or adopting a less traditionally feminine appearance after coming out. Participants also said they significantly less often wore dresses, used makeup, and shaved their legs and underarms. A significant decrease in body weight concern also occurred after coming out. Other changes in physical appearance are discussed. Participants believed that the changes were influenced by the opinions of other lesbians, their desire to signal prospective partners, and by becoming more comfortable with themselves. Implications of these results are discussed in terms of peer group norms, group identity, and sexual signaling.

Lesbian dating and courtship from young adulthood to midlife.

Abstract Lesbian dating and courtship were explored based on interviews with 38 predominantly white lesbians (ages 22-63) representing young adult, adult, and midlife age groups. Friendship was found to be the most widely used courtship script across all age groups, followed by the sexually explicit and romance scripts, with friendship and romance scripts being preferred. Unique aspects of lesbian dating cited by participants included freedom from gender roles, heightened intimacy/friendship, the rapid pace of lesbian relationship development, and the effects of prejudice. Friendship was found to be differentiated from romance by two main criteria: emotional intensity and sexual energy or contact. Verbal declarations of interest and nonverbal behaviors were the primary means of communicating sexual attraction. Few lesbians adhered to traditional gender roles in dating, and those who reported assuming the feminine reactive role nevertheless rejected the traditional notion that women should limit sexual contact. Overall, midlife lesbians were more purposive in their dating and more free from gender roles. Specifically, they were more concerned about the "attachment-worthiness" of a prospective partner and were significantly more likely than young adults to view dating as having a serious goal, to proceed at a rapid pace, to ask for a date, and to initiate physical intimacy.

Gender, social support, and PTSD in victims of violent crime.

Gender differences in social support levels and benefits were investigated in 118 male and 39 female victims of violent crime assessed for PTSD symptomatology 1 and 6 months postcrime. Within 1 month postcrime both genders reported similar levels of positive support and support satisfaction, but women reported significantly more negative responses from family and friends. Women also reported an excess of PTSD symptoms that was similar at 1 and 6 months postcrime, and negative responses mediated the relationship between gender and later symptoms. Overall negative response and support satisfaction, but not positive support, were significantly associated with PTSD symptoms. However, the effects of support satisfaction and negative response on 6-month symptoms were significantly greater for women than men. The findings are consistent with previous studies of predominantly female assault victims concerning the stronger impact of negative over positive support, and might help explain women's higher PTSD risk in civilian samples.

Brief screening instrument for post-traumatic stress disorder.

BACKGROUND: Brief screening instruments appear to be a viable way of detecting post-traumatic stress disorder (PTSD) but none has yet been adequately validated. AIMS: To test and cross-validate a brief instrument that is simple to administer and score. METHOD: Forty-one survivors of a rail crash were administered a questionnaire, followed by a structured clinical interview 1 week later. RESULTS: Excellent prediction of a PTSD diagnosis was provided by respondents endorsing at least six re-experiencing or arousal symptoms, in any combination. The findings were replicated on data from a previous study of 157 crime victims. CONCLUSIONS: Performance of the new measure was equivalent to agreement achieved between two full clinical interviews.