Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study protocol.

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, https://www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5000 richly phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.

Creating and Elaborating the Cultural Third: A Doers-Doing with Perspective on Psychoanalytic Supervision.

Although recognized as highly crucial to supervision practice (e.g., Tummala-Narra, 2004), culture has been addressed minimally in the psychoanalytic supervision literature. Calls to remedy that limitation have been made and making culture matter has been identified as a most pressing need for psychoanalytic supervision. But how then do we as supervisors go about doing that? How might we better position culture in, and make culture central to, our psychoanalytic supervisory conceptualization and conduct? We subsequently take up those questions, expanding upon our earlier proposals about cultural humility and the Cultural Third (Watkins and Hook, 2016) by (a) proposing a tripartite multicultural perspective (i.e., cultural humility-cultural comfort-cultural opportunities) as supervision sine qua non; (b) using recognition theory as a way to better understand that very process of Third creation and elaboration; and (c) providing a rupture/repair case example that shows efforts to create and build the Cultural Third in supervision. The Cultural Third is conceptualized as a product of doers-doing with so as to culturally learn together through "not knowing".

The impact of accommodating client preference in psychotherapy: A meta-analysis.

Client preferences in psychotherapy reflect specific conditions and activities that clients desire in their treatment, with increasing evidence pointing to preference accommodation as facilitating psychotherapy outcomes. This updated meta-analysis establishes the magnitude of the effect of client preference accommodation in psychotherapy. Based on data from 53 studies and over 16,000 clients, preference accommodation was associated with fewer treatment dropouts (OR = 1.79) and more positive treatment outcomes (d = 0.28) than providing client with a nonpreferred treatment or psychotherapy condition. The preference effect was moderated by study design, timing and type of outcome measurement, and client diagnosis. It was not moderated by year of publication, treatment duration, preference type, treatment options, client age, client gender, client ethnicity, or client years of education. The authors provide a case example of preference accommodation and practice recommendations for working with client preferences.

"The Worst Experience of My Life": The Internship Crisis and Its Impact on Students.

OBJECTIVE: The objective of the present study was to understand how internship applicants perceive themselves as being affected by the ongoing imbalance between the number of internship spots available and the number of applicants to internship. METHOD: The present study undertook a qualitative, and supplemental quantitative, analysis of 1,076 internship applicant responses to an item included in the 2011 postmatch survey asking participants how the internship crisis has affected them. RESULTS: Results indicated that the internship application process in general was viewed overwhelmingly negatively. Respondents described personal stress and system issues in their responses. Respondents described reciprocal stresses; applications spur on stresses, which are compounded by fears of not matching. Such fears cast negative light on training. Participants also described resiliencies that buffered against stresses and perceptions of discrimination or bias that add to stress. CONCLUSIONS: The implications of these findings for supporting students, working to resolve the internship crisis, and adapting policy are discussed.

Supervisor Allegiance as a Critical Construct: A Brief Communication.

Allegiance, long regarded as a significant variable in psychotherapy and psychotherapy research, has been ignored in the psychotherapy supervision literature. It is our contention that allegiance is similarly significant for psychotherapy supervision. In this brief communication, we define supervisor allegiance, consider its impact on supervision outcome, and highlight its role in the contextual supervision relationship model (a trans-theoretical model of the supervisory relationship).

Enhancing information pertaining to client characteristics to facilitate evidence-based practice.

OBJECTIVE: Evidence-based practice (EBP) includes utilization of empirically supported treatments, application of clinical expertise, and consideration of client characteristics. The following brief report aims to elucidate barriers in the study and dissemination of research regarding these client characteristics. DESIGN: Authors examined empirical papers cited on psychologicaltreatments.org (N = 338) and categorized each according to efficacy evidence available pertaining to gender, race/ethnicity, and socioeconomic status (SES). RESULTS: Gender was most commonly considered (7% of studies), with less than 2% of studies analyzing efficacy in relation to race/ethnicity or SES. CONCLUSIONS: Available findings are summarized according to disorder. Researchers are encouraged to attend to client variables in efficacy studies and suggestions are offered for training students to include client variables in EBP.

Effects of pre-session centering for therapists on session presence and effectiveness.

The present study tested whether engaging in a mindfulness centering exercise 5 minutes before a session could have a positive impact on therapy, in particular on the therapists' ability to remain present in session and on session outcomes. Results indicated that therapists perceived themselves as being more present in session when they prepared for their sessions by engaging in a mindfulness centering exercises (d=.45), while clients perceived their therapists as being highly present regardless of whether their therapist completed the mindfulness centering exercise. Clients did, however, perceive the sessions as being more effective when their therapists engaged in the mindfulness centering exercise prior to the start of the session (d=.52).

Self-reported concussion symptoms and training routines in mixed martial arts athletes.

Mixed martial arts (MMA) is a full-contact, fighting sport that has risen in popularity over recent years, resulting in an increase in both training facilities and sport participants. To date, little research has examined the complications and vulnerability to head trauma, or concussive symptomatology, in MMA athletes. In this study, we assessed relationships between training routines and concussive symptoms, as well as medical care, in MMA athletes. A sample (N = 119) of MMA athletes reported concussive symptoms, training routines, and medical histories through an online survey. Nearly 15% of the MMA athletes reported history of a knockout, and nearly one-third reported a technical knockout. Subjective ratings of concussive symptoms were high for these athletes, with many of them waiting only a brief time after such incidents to return to competition. These findings have important implications for informing the medical treatment and safety decision for returning to participation for these athletes.

Measurement invariance of commonly used psychosis-screening scales in U.S. Spanish- and English-speaking Hispanic participants.

Two of the most commonly used psychosis screening measures are the Prodromal Questionnaire-Brief (PQ-B) and the Youth Psychosis at Risk Questionnaire-Brief (YPARQ-B). Both scales have considerable support for the reliability and validity of their scores for use with English- and Spanish-speaking participants, with measurement equivalence established across a subset of demographic characteristics. However, measurement invariance has not been examined across several important demographic variables, including native language, language of the scales used with Hispanic participants, education, occupation, income, birth country, and generation status. In the present study, (N = 1,191) measurement invariance was examined for each of these variables across three samples (ns = 505, 714, and 126). The PQ-B total scores and YPARQ-B were found to demonstrate configural and scalar invariance, while PQ-B Distress scores displayed configural, metric, and scalar invariance across most tested demographic variables. Psychosis scores were associated with social determinants of health (SDoH) including major and everyday experiences of discrimination, food insecurity, financial insecurity, acculturation, and ethnic identity. The associations between psychosis and SDoH were mostly consistent across groups. Compared to White-non-Hispanic participants, Hispanic participants had higher scores on all psychosis measures and tended to have higher scores on discrimination, food and housing insecurity, affirmation aspects of ethnic identity, and acculturative stress. Despite differences in psychosis levels, the groups did not differ in history of treatment. Overall, these results provide strong evidence that the PQ-B and YPARQ provide equivalent, nonbiased, valid, and reliable scores in Hispanic and Non-Hispanic participants in both English and Spanish. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study Protocol.

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5,000 richly-phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.

Naturalistic changes in subjective distress outside of therapy.

OBJECTIVES: To establish the effectiveness or efficacy of psychological interventions, it is important to understand the nature of changes that occur in the absence of therapy. DESIGN: In this study, clinically distressed college students from 2 universities (n = 228) completed the Outcome Questionnaire (OQ)-45.2 on a weekly basis throughout a single semester. RESULTS: Although 56.6% of the sample made no change or deteriorated, 43.4% made a reliable improvement. Change status was predicted by previous therapy experience and length of study participation. Multilevel growth modeling also indicated that participants' OQ-45.2 scores decreased over time (following a cubic trend) and the amount of decrease was associated with Time 1 OQ-45.2 scores. CONCLUSIONS: Limitations of the study and further implications for treatment outcome research are discussed.

Preferences.

Client preferences are recognized as a key component to evidence-based practice; however, research has yet to confirm the actual influence preferences have on treatment outcome. In this meta-analysis, we summarize results from 35 studies that have examined the preference effect with adult clients. Overall, clients who were matched to their preferred therapy conditions were less likely to drop out of therapy prematurely (OR=.59, p<.001) and showed greater improvements in treatment outcomes (d=.31, p<.001). Type of preference (role, therapist, or treatment type) was not found to moderate the preference effect, but study design was found to be a significant moderator, with randomized controlled trials showing the largest differences between preference-matched clients and nonmatched clients. These results underscore the centrality of incorporating patient preferences when making treatment decisions. Clinical examples and therapeutic practices are provided.

Decreasing treatment dropout by addressing expectations for treatment length.

Therapy dropout or premature termination is a significant problem which impedes the delivery of psychotherapy services. In this study, a method aimed to reduce the occurrence of premature termination by addressing clients' duration expectations was examined. Sixty-three adult clients seeking psychotherapy services from a psychology department training clinic were randomized into control (n=32) and education groups (n=31). On average, those clients in the education group, who were provided information about the dose-effect model prior to their intake appointment, were found to stay in treatment significantly longer (d=0.55) and were more likely to be classified as therapy completers (RR=3.55) when compared to clients in the control group.

Inviting ASPPB to address systemic bias and racism: Reply to Turner et al. (2021).

Turner et al. (2021) subtly relapse in conceptualizing the Examination for Professional Practice in Psychology (Part 2-Skills) exam as a competency evaluation despite Association of State and Provincial Psychology Boards' (ASPPB) prior concession that Part 2 measures only the knowledge of skills (not skill competency). They do not address the purpose of redundant evaluation or the other concerns raised in Callahan et al. (2020). Instead, Turner et al. remain narrowly focused on defense of content validity and a reliance on outdated standards that fail to meet contemporary expectations for assessment of health care professionals. The adopted processes and procedures, albeit time consuming and effortful, are known to be methodologically inadequate. ASPPB's methods demonstrably foster linguistic biases and systemic racism that constricts licensure of diverse individuals as psychologists. Specific suggestions are offered, and ASPPB is urged to take drastic corrective action. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Posttraumatic stress disorder in daily life among World Trade Center responders: Temporal symptom cascades.

BACKGROUND: Posttraumatic stress disorder (PTSD) symptoms are common in the immediate aftermath of a trauma, but it is their persistence over time that leads to a diagnosis. This pattern highlights the critical role of symptom maintenance to understanding and treating the disorder. Relatively few studies have explored whether PTSD symptoms may be interacting or triggering one another to worsen and maintain the disorder, a dynamic we refer to as "symptom cascades." Additionally, little work has tested in real-time how other maintenance factors, such as stress, contribute to such events in daily life. METHODS: The present study in a group (N = 202) of World Trade Center (WTC) responders oversampled for PTSD tested day-to-day temporal associations among PTSD symptom dimensions (i.e., intrusions, avoidance, numbing, and hyperarousal) and stress across one week. RESULTS: Longitudinal models found hyperarousal on a given day predicted increased PTSD symptoms the next day, with the effect sizes almost double compared to other symptom dimensions or daily stress. Intrusions, in contrast, showed little prospective predictive effects, but instead were most susceptible to the effects from other symptoms the day before. Avoidance and numbing showed weaker bidirectional effects. LIMITATIONS: Findings are from a unique population and based on naturalistic observation. CONCLUSIONS: Results are consistent with the idea of symptom cascades, they underscore hyperarousal's strong role in forecasting short-term increases in PTSD (even more than stress per se) and they raise the prospect of highly specific ecological momentary interventions to potentially disrupt PTSD maintenance in daily life.

A comparison of client preferences for intervention empirical support versus common therapy variables.

Client preferences have been identified as an essential part of evidence-based practice in psychology. Further, client preferences have been found to play an important role in determining premature termination and therapy outcomes. However, our current understanding of this client variable is limited because of the methodologies that have previously been used to assess these preferences. In this study, 57 adult clients from a university-based psychology department clinic completed an instrument weighing preferences for intervention specific empirical support against preferences for 4 other common factor variables. These clients were found to discount a significant amount of intervention empirical support to ensure the following: (a) a satisfactory therapeutic relationship could be developed, (b) their therapist would be empathetic and accepting, (c) their therapist would have a greater level of experience, and (d) they, as clients, would do more of the talking during sessions. These findings suggest that clients prefer treatment decisions to be based on variables other than intervention empirical support alone. Recommendations are made for assessing and including client preferences to provide more individually tailored interventions.

An examination of applicant characteristics of successfully matched interns: is the glass half full or half empty and leaking miserably?

Although the "balance" between the number of potential interns and the number of internship slots needs be addressed, it is imperative that more attention be devoted to examining applicant and program characteristics that result in a successful match. To that end, the current study included pre- and post-match data provided by 330 applicants of the 2009 Association of Psychology Postdoctoral and Internship Centers Match system. In this sample, we found very little evidence that applicant characteristics are related to match outcome. Suggestions to applicants and directors of training are provided and understudied variables and needed analyses are identified. Policy considerations are discussed in terms of not only resolving the supply and demand imbalance but also improving the application process and clearinghouse system.

The enhanced examination for professional practice in psychology: A viable approach?

Health disciplines have increasingly required competency-based evaluations as a licensure prerequisite. In keeping with this trend, the Association of State and Provincial Psychology Boards (ASPPB) has begun to develop a second part to the Examination for Professional Practice in Psychology (EPPP). The resulting 2-part examination is collectively referred to as the Enhanced EPPP. Part 1 of the Enhanced EPPP, which consists of the current exam, is designed to be an assessment of knowledge. Part 2 of the Enhanced EPPP is newly developed and intended to address the need for a competency-based evaluation. To date, ASPPB has addressed some standard facets of validity for the EPPP Part 2, but not others. In addition, the EPPP Part 2 has yet to be subjected to a broader validation process, in which the suitability of the test for its intended purpose is evaluated. Implementation of the EPPP Part 2 before validation could have negative consequences for those seeking to enter the profession and for the general public (e.g., potential restriction of diversity in the psychology workforce). For jurisdictions implementing the EPPP Part 2, failure to gather and report the evidence required for use of a test in a forensic context may also open the door for legal challenges. We end with suggestions for feasible research that could significantly enhance the validation process for the EPPP Part 2 and offer jurisdictions concrete suggestions of features to look for in determining whether and when to implement the Enhanced EPPP. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Long-term Changes in Cognitive Functioning in Individuals With Psychotic Disorders: Findings From the Suffolk County Mental Health Project.

Importance: It remains uncertain whether people with psychotic disorders experience progressive cognitive decline or normal cognitive aging after first hospitalization. This information is essential for prognostication in clinical settings, deployment of cognitive remediation, and public health policy. Objective: To examine long-term cognitive changes in individuals with psychotic disorders and to compare age-related differences in cognitive performance between people with psychotic disorders and matched control individuals (ie, individuals who had never had psychotic disorders). Design, Setting, and Participants: The Suffolk County Mental Health Project is an inception cohort study of first-admission patients with psychosis. Cognitive functioning was assessed 2 and 20 years later. Patients were recruited from the 12 inpatient facilities of Suffolk County, New York. At year 20, the control group was recruited by random digit dialing and matched to the clinical cohort on zip code and demographics. Data were collected between September 1991 and July 2015. Analysis began January 2016. Main Outcomes and Measures: Change in cognitive functioning in 6 domains: verbal knowledge (Wechsler Adult Intelligence Scale-Revised vocabulary test), verbal declarative memory (Verbal Paired Associates test I and II), visual declarative memory (Visual Reproduction test I and II), attention and processing speed (Symbol Digit Modalities Test-written and oral; Trail Making Test [TMT]-A), abstraction-executive function (Trenerry Stroop Color Word Test; TMT-B), and verbal fluency (Controlled Oral Word Association Test). Results: A total of 705 participants were included in the analyses (mean [SD] age at year 20, 49.4 [10.1] years): 445 individuals (63.1%) had psychotic disorders (211 with schizophrenia spectrum [138 (65%) male]; 164 with affective psychoses [76 (46%) male]; 70 with other psychoses [43 (61%) male]); and 260 individuals (36.9%) in the control group (50.5 [9.0] years; 134 [51.5%] male). Cognition in individuals with a psychotic disorder declined on all but 2 tests (average decline: d = 0.31; range, 0.17-0.54; all P < .001). Cognitive declines were associated with worsening vocational functioning (Visual Reproduction test II: r = 0.20; Symbol Digit Modalities Test-written: r = 0.25; Stroop: r = 0.24; P < .009) and worsening negative symptoms (avolition: Symbol Digit Modalities Test-written: r = -0.24; TMT-A: r = -0.21; Stroop: r = -0.21; all P < .009; inexpressivity: Stroop: r = -0.22; P < .009). Compared with control individuals, people with psychotic disrders showed age-dependent deficits in verbal knowledge, fluency, and abstraction-executive function (vocabulary: ß = -0.32; Controlled Oral Word Association Test: ß = -0.32; TMT-B: ß = 0.23; all P < .05), with the largest gap among participants 50 years or older. Conclusions and Relevance: In individuals with psychotic disorders, most cognitive functions declined over 2 decades after first hospitalization. Observed declines were clinically significant. Some declines were larger than expected due to normal aging, suggesting that cognitive aging in some domains may be accelerated in this population. If confirmed, these findings would highlight cognition as an important target for research and treatment during later phases of psychotic illness.

The impact of client treatment preferences on outcome: a meta-analysis.

An important part of evidence-based practice is to include client preferences in the treatment decision-making process. However, based on previous reviews of the literature there is some question as to whether including client preferences actually has an effect on treatment outcome. This meta-analytic review summarized data from over 2,300 clients across 26 studies comparing the treatment outcome differences between clients matched to a preferred treatment and clients not matched to a preferred treatment. The findings indicate a small significant effect (r=.15, CI(.95): .09 to .21) in favor of clients who received a preferred treatment. The binomial effect size indicated that matched clients have a 58% chance of showing greater improvement, and further analysis indicate that they are about half as likely to drop-out of treatment when compared with clients not receiving a preferred treatment. Study design was seen to be a moderating variable in that partially randomized preference trials may underestimate the treatment preference effect. Implications for best practice standards are discussed.