Renewed Feedback-Informed Group Treatment for Patients with Anxiety and Depressive Disorders.

Feedback-Informed Group Treatment (FIGT) shows promise for improving outcomes, but results are mixed. The aim was investigating the feasibility, acceptability and effects of renewed FIGT on clinical outcomes and therapy processes. In a quasi-experimental pilot study, 65 patients with anxiety or depressive disorders and 15 therapists of interpersonal psychotherapy or cognitive behavioural therapy groups using renewed FIGT were included. Renewed FIGT contained three additions compared to the previous tool: (1) personalized goals along with the Outcome Questionnaire-45 (OQ-45), (2) therapists' training, coaching and intervision, and (3) instructions to actively use feedback in the group. Data on feasibility, acceptability, outcomes and process factors were analysed and compared with those of historical cohorts using only OQ-45 feedback or no feedback, using descriptive, multilevel and covariance statistical analyses. Feasibility was mostly improved, with patients experiencing more feedback discussions and better usability compared to only OQ-45 feedback. At least two thirds of the patients and therapists give preference to using feedback in the future. At the end of the study, therapists were less convinced that the OQ-45 and goals were able to detect change. Renewed FIGT did not improve effectiveness on clinical outcomes. Compared to no feedback, patients experienced more cohesion, engagement and less avoidance, but improved less on depressive symptoms. Even when renewed FIGT is more feasible and usable than only OQ-45 feedback and associated with more cohesiveness and engagement, it may not automatically lead to improved effectiveness on clinical outcomes in short-term group therapy. Implications and future directions are described.

The feasibility, acceptability and effectiveness of a feedback-informed group treatment (FIGT) tool for patients with anxiety or depressive disorders.

Monitoring treatment progress by the use of standardized measures in individual therapy, also called feedback-informed treatment (FIT), has a small but significant effect on improving outcomes. Results of FIT in group therapy settings are mixed, possibly due to contextual factors. The goals of this study were to investigate the feasibility, acceptability and effectiveness of a feedback-informed group treatment (FIGT) tool, based on the principles of the Contextual Feedback Theory and earlier FIGT research. Patients with anxiety or depressive disorders following interpersonal or cognitive behavioural group psychotherapy (IPT-G or CBT-G) were randomized to either feedback (n=104) or Treatment As Usual (TAU; n=93). In the feedback condition, patients filled out the Outcome-Questionnaire 45 (OQ-45) weekly in a FIGT tool and therapists were instructed to discuss the results in each session. Dropout, attendance and outcomes were measured. Additionally, in the feedback condition, OQ-45 response, feedback discussions and acceptability by patients and therapists were assessed. Results showed no differences on dropout, but lower attendance rates in the feedback condition. Although therapists reported high rates of feedback use and helpfulness, patients experienced that results were discussed with them only half of the time and they were also less optimistic about its usefulness. The findings indicate that the FIGT instrument was partially feasible, more acceptable to therapists than patients, and was not effective as intended. Future research is needed to discover how feedback can be beneficial for both therapists and patients in group therapy.

On the use of positive test strategies when diagnosing mental disorders.

BACKGROUND: Despite the adverse impact diagnostic errors can have, clinical interviewing and decision-making in psychiatric practice have received relatively little empirical attention. When diagnosing patients, clinicians tend to fall back on a specific (heuristic) rule of thumb, the positive test strategy, a confirmatory approach that increases the risk of confirmation bias. METHOD AND RESULTS: A group of 83 clinical psychologists and psychiatrists was asked to give their diagnostic hypotheses about two vignettes. We found them to self-generate significantly (i.e., p < .01; d = 1.57) more confirming than disconfirming questions to test their initial diagnostic impressions, with supervisors considering significantly more differential diagnoses than the less experienced post-grads/residents. When offered a list of 100 potentially relevant diagnostic queries, the supervisors selected fewer confirming and proportionally more disconfirming themes. CONCLUSIONS: Our results demonstrate that irrespective of clinical experience mental-health clinicians indeed tend to use a confirmatory thinking style that contrasts with the stricter principle of falsification. More field-based research on this topic is needed, as well as studies probing whether a systematized diagnostic approach is feasible in psychiatric practice and increases diagnostic accuracy and patient satisfaction.

Feedback-informed Group Treatment: A Qualitative Study of the Experiences and Needs of Patients and Therapists.

Therapists, including group therapists, can systematically gather feedback from patients about how their group members are responding to treatment. However, results of research on using feedback-informed group treatment (FIGT) are mixed, and the underlying mechanisms responsible for positive patient changes remain unclear. Therefore, the present qualitative study examined the perceptions and experiences of both (a) group therapists and (b) group members regarding using feedback in their therapy groups to gauge treatment progress, across five different therapy groups. Specifically, three interpersonal psychotherapy groups and two cognitive-behavioral therapy groups used a FIGT tool in which treatment progress updates were provided to patients and therapists. Observational data were collected in the form of feedback discussions in these therapy groups, as well as during interviews conducted with patients and therapists. Data were analyzed using thematic analysis and a grounded theory approach. Overall, patients were mostly positive about their experiences with FIGT, but therapists also expressed concerns about FIGT. Results indicated that FIGT is useful for gaining insight and strengthening the working alliance. In addition, specific group processes were also found to be important, especially interpersonal learning, cohesion, and social comparison. Practical implications are discussed.

Firearm examination: Examiner judgments and computer-based comparisons.

Forensic firearm examination provides the court of law with information about the source of fired cartridge cases. We assessed the validity of source decisions of a computer-based method and of 73 firearm examiners who compared breechface and firing pin impressions of 48 comparison sets. We also compared the computer-based method's comparison scores with the examiners' degree-of-support judgments and assessed the validity of the latter. The true-positive rate (sensitivity) and true-negative rate (specificity) of the computer-based method (for the comparison of both the breechface and firing pin impressions) were 94.4% and at least 91.7%, respectively. For the examiners, the true-positive rate was at least 95.3% and the true-negative rate was at least 86.2%. The validity of the source decisions improved when the evaluations of breechface and firing pin impressions were combined and for the examiners also when the perceived difficulty of the comparison decreased. The examiners were reluctant to provide source decisions for "difficult" comparisons even though their source decisions were mostly correct. The correlation between the computer-based method's comparison scores and the examiners' degree-of-support judgments was low for the same-source comparisons to negligible for the different-source comparisons. Combining the outcomes of computer-based methods with the judgments of examiners could increase the validity of firearm examinations. The examiners' numerical degree-of-support judgments for their source decisions were not well-calibrated and showed clear signs of overconfidence. We suggest studying the merits of performance feedback to calibrate these judgments.

Cognitive biases in the peer review of bullet and cartridge case comparison casework: A field study.

OBJECTIVE: Forensic judgments and their peer review are often the result of human assessment and are thus subjective and prone to bias. This study examined whether bias affects forensic peer review. HYPOTHESES: We hypothesized that the probability of disagreement between two forensic examiners about the proposed conclusion would be higher with "blind" peer review (reviewer saw only the first examiner's comparison photos) than with "non-blind" peer review (reviewer also saw the first examiner's interpretation and proposed conclusion). We also hypothesized that examiners with a higher perceived professional status would have a larger effect on the reported conclusion than examiners with a lower status. METHOD: We acquired data during a non-blind and a blind peer review procedure in a naturalistic, covert study with eight examiners (3-26 years of experience). We acquired 97 conclusions of bullet and cartridge case comparisons in the blind and 471 in the non-blind peer review procedure. RESULTS: The odds of disagreement between examiners about the evidential strength of a comparison were approximately five times larger (95%-CI [3.06, 8.50]) in the blind than in the non-blind procedure, with disagreement about 42.3% and 12.5% of the proposed conclusions, respectively. Also, the odds that their proposed conclusion was reported as the final conclusion were approximately 2.5 higher for the higher-status examiners than for lower-status examiners. CONCLUSIONS: Our results support both the hypothesis that bias occurs during non-blind forensic peer review and the hypothesis that higher-status examiners determine the outcome of a discussion more than lower-status examiners. We conclude that blind peer review may reduce the probability of bias and that status effects have an impact on the peer reviewing process.

Assessing the frequency of general fingerprint patterns by fingerprint examiners and novices.

The rarity of general fingerprint patterns should be taken into account in the assessment of fingerprint evidence to provide a more complete assessment of fingerprint evidence than when only considering the minutiae. This should be done because, the rarer the corresponding pattern, the stronger the support for the hypothesis that the fingermark stems from the same source as the reference fingerprint. Fingerprint examiners' experience should enable them to provide meaningful assessments of the frequencies of these general patterns according to the theories of perceptual learning, exemplar theory of categorization and visual statistical learning. In this study we examined the accuracy of fingerprint examiners' and novices' judgments on the rarity of general fingerprint patterns. We found that fingerprint examiners seem to have acquired some knowledge about the rarity of general patterns, but had difficulty expressing this knowledge quantitatively using a novel sub-classification of general patterns. As a consequence, their judgments were not accurate and they did not perform better on this task than novices. For both participant groups judgments of more common patterns were more accurate. However, examiners did outperform novices in rank ordering general patterns from common to rare. We conclude that our study does not show that fingerprint examiners have expertise in explicitly judging frequencies of novel sub-classifications of general fingerprint patterns, but our results do indicate that the examiners have acquired knowledge about the rarity of patterns that novices do not possess.

Art activities and qigong exercise for the well-being of older adults in nursing homes in Indonesia: a randomized controlled trial.

Objective: This study aims to investigate the effect of an integrated intervention of art activities and Qigong exercise on the well-being of older adults in nursing homes in Indonesia.Method: We employed a randomized controlled trial with 4 specific groups, i.e. art, Qigong, integration of art and Qigong, and control group. A total of 267 participants aged 50 years or older were recruited from 9 nursing homes in Jakarta, Indonesia. The participants were randomly allocated to one of the four groups, attending two intervention sessions per week for eight weeks (16 sessions), lasting 90 minutes each. Measurements were administered at baseline (T0) and post-intervention (T1). The primary outcome was well-being (WHOQOL-Bref) and secondary outcomes were satisfaction with life (SWLS), depression (BDI-II), and health status (SF-36).Results: The art intervention had a significant positive effect on well-being, in particular in the domain of social relations. It also led to a decrease in depressive symptoms, as did the integration intervention. No significant effects were visible in the Qigong group nor in the integrated intervention compared to either art or Qigong alone.Conclusion: Interventions such as art programs and an integration of art and Qigong may give psychological benefits to older adults. Yet, results of the study need to be interpreted with caution and need to be replicated. A qualitative approach would be welcome to get an in-depth understanding of why art intervention is especially beneficial. (Trial registration: Clinicaltrials.gov NCT02957773, registered 28 September 2016).

Validity and reliability of forensic firearm examiners.

Forensic firearm examiners compare the features in cartridge cases to provide a judgment addressing the question about their source: do they originate from one and the same or from two different firearms? In this article, the validity and reliability of these judgments is studied and compared to the outcomes of a computer-based method. The features we looked at were the striation patterns of the firing pin aperture shear marks of four hundred test shots from two hundred Glock pistols, which were compared by a computer-based method. Sixty of the resulting 79,800 comparisons were shown to 77 firearm examiners. They were asked to judge whether the cartridge cases had the same source or a different source, and to indicate the degree of support the evidence provided for those judgments. The results show that the true positive rates (sensitivity) and the true negative rates (specificity) of firearm examiners are quite high. The examiners seem to be slightly less proficient at identifying same-source comparisons correctly, while they outperform the used computer-based method at identifying different-source comparisons. The judged degrees of support by examiners who report likelihood ratios are not well-calibrated. The examiners are overconfident, giving judgments of evidential strength that are too high. The judgments of the examiners and the outcomes of the computer-based method are only moderately correlated. We suggest to implement performance feedback to reduce overconfidence, to improve the calibration of degree of support judgments, and to study the possibility of combining the judgments of examiners and the outcomes of computer-based methods to increase the overall validity.

The Effectiveness of Combining Visual Art Activities and Physical Exercise for Older Adults on Well-Being or Quality of Life and Mood: A Scoping Review.

Visual art activities and physical exercise are both low-intensity and low-cost interventions. The present study aims to comprehensively describe published literature on the effectiveness of a combination of these interventions on well-being or quality of life (QoL) and mood of older adults. Embase, CINAHL, Ovid Medline (R), PsycINFO, and Web of Science databases were searched for studies published between 1990 and 2015 that evaluated interventions combining visual art therapy and exercise for people aged 50 years or older with at least one resultant well-being or QoL or mood outcome. We found 10 studies utilizing different combination programs and outcome measures, and most had small sample sizes. Seventy percent of the studies reported that combining both interventions was effective in improving well-being or QoL and mood in older adults. Future studies are, however, requisite to investigate whether in the respective population such a combination is more effective than either of the interventions alone.

All's Bad That Ends Bad: There Is a Peak-End Memory Bias in Anxiety.

The peak-end memory bias has been well documented for the retrospective evaluation of pain. It describes that the retrospective evaluation of pain is largely based on the discomfort experienced at the most intense point (peak) and at the end of the episode. This is notable because it means that longer episodes with a better ending can be remembered as less aversive than shorter ones; this is even if the former had the same peak in painfulness and an overall longer duration of pain. Until now, this bias has not been studied in the domain of anxiety despite the high relevance of variable levels of anxiety in the treatment of anxiety disorders. Therefore, we set out to replicate the original studies but with an induction of variable levels of anxiety. Of 64 women, half watched a clip from a horror movie which ended at the most frightening moment. The other half watched an extended version of this clip with a moderately frightening ending. Afterward, all participants were asked to rate the global anxiety which was elicited by the video. When the film ended at the most frightening moment, participants retrospectively reported more anxiety than participants who watched the extended version. This is the first study to document that the peak-end bias can be found in the domain of anxiety. These findings require replication and extension to a treatment context to evaluate its implications for exposure therapy.

Reasons for placement decisions in a case of suspected child abuse: The role of reasoning, work experience and attitudes in decision-making.

Child welfare and child protection workers regularly make placement decisions in child abuse cases, but how they reach these decisions is not well understood. This study focuses on workers' rationales. The aim was to investigate the kinds of arguments provided in placement decisions and whether these arguments were predictors for the decision, in addition to the decision-makers' risk assessment, work experience and attitudes towards placement. The sample consisted of 214 professionals and 381 students from the Netherlands. The participants were presented with a vignette describing a case of alleged child abuse and were asked to determine whether the abuse was substantiated, to assess risks and to recommend an intervention. The participants' placement attitudes were assessed using a structured questionnaire. We found that the participants provided a wide range of arguments, but that core arguments - such as the suspected abuse, parenting and parent-child interaction - were often missing. Regression analyses showed that the higher the perceived danger to the child and the more positive the participants' attitudes towards placement, the more likely the participants would be to propose placing the child in care. Arguments related to the severity of the problems (i.e., suspected abuse, parenting and the child's development) as well as the parents' perceived cooperation also influenced placement decisions. The findings indicate trends in the decision-making process, in the sense that participants who decided to place the child out-of-home emphasized different arguments and had different attitudes towards out-of-home placement than those who did not. We discuss the implications of our findings.

The impact of vaccination and patient characteristics on influenza vaccination uptake of elderly people: A discrete choice experiment.

OBJECTIVES: To improve information for patients and to facilitate a vaccination coverage that is in line with the EU and World Health Organization goals, we aimed to quantify how vaccination and patient characteristics impact on influenza vaccination uptake of elderly people. METHODS: An online discrete choice experiment (DCE) was conducted among 1261 representatives of the Dutch general population aged 60 years or older. In the DCE, we used influenza vaccination scenarios based on five vaccination characteristics: effectiveness, risk of severe side effects, risk of mild side effects, protection duration, and absorption time. A heteroscedastic multinomial logit model was used, taking scale and preference heterogeneity (based on 19 patient characteristics) into account. RESULTS: Vaccination and patient characteristics both contributed to explain influenza vaccination uptake. Assuming a base case respondent and a realistic vaccination scenario, the predicted uptake was 58%. One-way changes in vaccination characteristics and patient characteristics changed this uptake from 46% up to 61% and from 37% up to 95%, respectively. The strongest impact on vaccination uptake was whether the patient had been vaccinated last year, whether s/he had experienced vaccination side effects, and the patient's general attitude towards vaccination. CONCLUSIONS: Although vaccination characteristics proved to influence influenza vaccination uptake, certain patient characteristics had an even higher impact on influenza vaccination uptake. Policy makers and general practitioners can use these insights to improve their communication plans and information regarding influenza vaccination for individuals aged 60 years or older. For instance, physicians should focus more on patients who had experienced side effects due to vaccination in the past, and policy makers should tailor the standard information folder to patients who had been vaccinated last year and to patient who had not.

Parentification, Stress, and Problem Behavior of Adolescents who have a Parent with Mental Health Problems.

When adolescents live with a parent with mental illness, they often partly take over the parental role. Little is known about the consequences of this so-called parentification on the adolescents' internalizing and externalizing problems. This survey study examined this effect cross-sectionally and longitudinally in a sample of 118 adolescents living with a parent suffering from mental health problems. In addition, the study examined a possible indirect effect via perceived stress. Path analyses were used to examine the direct associations between parentification and problem behavior as well as the indirect relations via perceived stress. The results showed that parentification was associated with both internalizing and externalizing problems cross-sectionally, but it predicted only internalizing problems 1 year later. An indirect effect of parentification on adolescent internalizing and externalizing problems via perceived stress was found, albeit only cross-sectionally. These findings imply that parentification can be stressful for adolescents who live with a parent with mental health problems, and that a greater awareness of parentification is needed to prevent adolescents from developing internalizing problems.

Sex Bias in Classifying Borderline and Narcissistic Personality Disorder.

This study investigated sex bias in the classification of borderline and narcissistic personality disorders. A sample of psychologists in training for a post-master degree (N = 180) read brief case histories (male or female version) and made DSM classification. To differentiate sex bias due to sex stereotyping or to base rate variation, we used different case histories, respectively: (1) non-ambiguous case histories with enough criteria of either borderline or narcissistic personality disorder to meet the threshold for classification, and (2) an ambiguous case with subthreshold features of both borderline and narcissistic personality disorder. Results showed significant differences due to sex of the patient in the ambiguous condition. Thus, when the diagnosis is not straightforward, as in the case of mixed subthreshold features, sex bias is present and is influenced by base-rate variation. These findings emphasize the need for caution in classifying personality disorders, especially borderline or narcissistic traits.

Decision making in child protection: An international comparative study on maltreatment substantiation, risk assessment and interventions recommendations, and the role of professionals' child welfare attitudes.

Child welfare professionals regularly make crucial decisions that have a significant impact on children and their families. The present study presents the Judgments and Decision Processes in Context model (JUDPIC) and uses it to examine the relationships between three independent domains: case characteristic (mother's wish with regard to removal), practitioner characteristic (child welfare attitudes), and protective system context (four countries: Israel, the Netherlands, Northern Ireland and Spain); and three dependent factors: substantiation of maltreatment, risk assessment, and intervention recommendation. The sample consisted of 828 practitioners from four countries. Participants were presented with a vignette of a case of alleged child maltreatment and were asked to determine whether maltreatment was substantiated, assess risk and recommend an intervention using structured instruments. Participants' child welfare attitudes were assessed. The case characteristic of mother's wish with regard to removal had no impact on judgments and decisions. In contrast, practitioners' child welfare attitudes were associated with substantiation, risk assessments and recommendations. There were significant country differences on most measures. The findings support most of the predictions derived from the JUDPIC model. The significant differences between practitioners from different countries underscore the importance of context in child protection decision making. Training should enhance practitioners' awareness of the impact that their attitudes and the context in which they are embedded have on their judgments and decisions.

Different answers to different questions: exploring clinical decision making by general practitioners and psychiatrists about depressed patients.

PURPOSE: Exploring three perspectives on differences between general practitioners (GP) and psychiatrists in clinical decision making about depressed patients. The gold standard perspective focuses on differences in decisions (output) as a result of lack of expertise, the input perspective relates differences to different information use and to other roles, and the throughput perspective attributes differences to other information processing. METHODS: Twenty-six psychiatrists and 25 GPs gave their clinical judgment on four on-line vignettes of increasingly severely depressed patients. Supplementary information on 15 themes could be asked for by clicking on underlined phrases. Dependent variables were the amount and type of extra information used, time needed and judgments of the severity of symptoms, appropriate treatment and health care providers. RESULTS: Compared to psychiatrists, GPs were more reluctant to refer to specialized care, they needed less supplementary information and reached their conclusion in less time. Their processing of information appeared to be more contextual. Psychiatrists used a more stable procedure in which information inspection took place independently of differences in the vignettes. CONCLUSIONS: GPs and psychiatrists not only give different answers (treatment advices) because they have different expertise, but also because they have different questions due to other roles, and they use different clinical decision procedures. Insight in these differences can be useful for ameliorating collaborative mental health care.

Effect of Type D personality on medication adherence in early adolescents with asthma.

OBJECTIVE: Medication adherence for daily preventive asthma medication is especially low during adolescence. In the present study, we aimed to test whether Type D personality (both as a category and with its constituent components (negative affectivity: NA and social inhibition: SI) separately and in interaction) predicts medication adherence of early adolescents with asthma. METHODS: In a prospective study, 188 early adolescents with asthma who were prescribed daily preventive asthma medication completed questionnaires on Type D personality, medication adherence, socio-demographic and clinical information, and depressive symptoms in the Spring/Summer of 2011 (T1) and again 12months later (T2). Multiple regression analyses, controlling for demographic and clinical information and for depressive symptoms, were conducted to test whether Type D personality (either as a categorical or dimensional construct) predicted changes in medication adherence over time. RESULTS: Adherence was significantly lower at T2 than at T1 and this decrease was predicted by the categorical construct of Type D personality. Analyses of the two separate dimensions NA and SI and their interaction showed that higher scores on NA at T1 predicted more decrease in adherence over time. Neither SI nor the interaction between NA and SI predicted changes in adherence. CONCLUSION: This is the first study to test the relationship between Type D personality and medication adherence in adolescents. Although categorical Type D personality predicts mediation adherence of adolescent with asthma over time, dimensional analyses suggest that this is due to negative affectivity only, and not to the combination of negative affectivity and social inhibition.

Remembering and diagnosing clients: does experience matter?

Experienced mental health clinicians often do not outperform novices in diagnostic decision making. In this paper we look for an explanation of this phenomenon by testing differences in memory processes. In two studies we aimed to look at differences in accuracy of diagnoses in relation to free recall of client information between mental health clinicians with different levels of experience. Clinicians were presented with two cases, and were asked afterwards, either directly (Study 1) or after 1 week (Study 2), to give the appropriate diagnoses and to write down what they remembered of the cases. We found in Study 1 that the accuracy of the diagnoses was the same for all levels of experience, as was the amount of details recalled. Very experienced clinicians did remember more higher-order concepts, that is, abstractions from the presented information. In Study 2 we found that the very experienced clinicians were less accurate in their diagnoses and remembered fewer details than the novices. In response to these findings we further discuss their implications for psychodiagnostic practice.

Causal client models in selecting effective interventions: a cognitive mapping study.

An important reason to choose an intervention to treat psychological problems of clients is the expectation that the intervention will be effective in alleviating the problems. The authors investigated whether clinicians base their ratings of the effectiveness of interventions on models that they construct representing the factors causing and maintaining a client's problems. Forty clinical child psychologists drew causal models and rank ordered interventions according to their expected effectiveness for 2 cases. The authors found that different clinicians constructed different causal models for the same client. Also, the authors found low to moderate agreement about the effectiveness of different interventions. Nevertheless, the authors could predict clinicians' ratings of effectiveness from their individual causal models.