The promise of science-based training and application in psychological clinical science.

Baker, McFall, and Shoham (2008) analyzed and critiqued the state of training in clinical psychology, asserting that much of this training is not sufficiently influenced by science. They asserted that the emergent demands of health care, with its attendant costs and resource constraints, require that mental and behavioral health care become increasingly efficient, effective, and cost-effective. Baker et al. (2008) then offered examples of how science-based evidence and methods could influence training in clinical psychology to achieve those goals. Laska, Gurman, and Wampold (2014, pp. 467-481) critiqued aspects of the Baker et al. (2008) paper. In the current paper, we argue that Laska et al. (2014) misconstrued points made in the early Baker paper. We also assert that evidence of common factors in psychological interventions is in no way antithetical or problematic to a science-based approach to clinical training and application. Further, we argue for a multidimensional approach to evaluating intervention performance, one that involves an evaluation of efficacy, effectiveness, cost-effectiveness, translation potential, and so on. Finally, we discuss how researchers can most efficiently develop intervention methods and delivery systems that are superior to the induction of common factors per se.

The relationship between women's response effectiveness and a history of sexual victimization.

This study evaluated the effects of a sexual victimization history and the contextual features of sexual activity and alcohol use on the effectiveness of women's responses to 44 written vignettes describing diverse dating and social situations. One hundred and one undergraduate women reported their history of sexual victimization and provided written descriptions of how they would respond to each vignette. Experts in the sexual violence research area then evaluated the effectiveness of these responses in decreasing risk of having an unwanted sexual experience, meaning one in which the woman is verbally or physically coerced into having sexual contact of any kind with a man. Results revealed that past victimization moderated the influence of the situations' contextual features on women's response effectiveness. Specifically, as the presence of sexual activity increased in the situations, the response effectiveness of more severely victimized women increased less than nonvictimized women. In addition, as the presence of alcohol increased in the situations the response effectiveness of more severely victimized women decreased more than that of nonvictimized women.

Cognitive processes underlying women's risk judgments: associations with sexual victimization history and rape myth acceptance.

OBJECTIVE: This study evaluated the effects of sexual victimization history, rape myth acceptance, implicit attention, and recent learning on the cognitive processes underlying undergraduate women's explicit risk judgments. METHOD: Participants were 194 undergraduate women between 18 and 24 years of age. The sample was ethnically diverse and composed primarily of freshman, heterosexual, and single women. Stimuli were written vignettes describing social situations that varied on dimensions of sexual victimization risk and potential impact on women's popularity. Participants completed cognitive tasks assessing relative attention to victimization risk versus popularity impact, learning about either risk or popularity impact, and explicit classification of victimization risk. Participants then completed the Sexual Experiences Survey (SES) and the Rape Myth Acceptance Scale; SES responses were used to quantify the severity of victimization experiences. RESULTS: More severe victimization history predicted use of higher thresholds for judging situations as risky, as well as lower sensitivity to risk and greater sensitivity to popularity impact when judging risk. Greater rape myth acceptance also predicted lower sensitivity to risk information. Higher relative attention to victimization risk predicted greater sensitivity to risk information when judging risk. Recent learning about either the risk or the popularity impact aspects of social situations modified sensitivity to risk versus popularity when making risk judgments. CONCLUSION: The study emphasizes the importance of distinguishing the threshold for judging situations as risky from sensitivity to risk-relevant information in understanding individual differences in women's risk judgments. Both processes may be important to consider when developing interventions to reduce women's risk for sexual victimization.

Perceptual mechanisms that characterize gender differences in decoding women's sexual intent.

Men and women often disagree about the meaning of women's nonverbal cues, particularly those conveying dating-relevant information. Men perceive more sexual intent in women's behavior than women perceive or report intending to convey. Although this finding has been attributed to gender differences in the threshold for labeling ambiguous cues as sexual in nature, little research has been conducted to determine etiology. Using a model that differentiates perceptual sensitivity from decisional bias, we found no evidence that men have lenient thresholds for perceiving women's nonverbal behavior as indicating sexual interest. Rather, gender differences were captured by a relative perceptual insensitivity among men. Just as in previous studies, men were more likely than women to misperceive friendliness as sexual interest, but they also were quite likely to misperceive sexual interest as friendliness. The results point to the promise of computational models of perception in increasing the understanding of clinically relevant social processes.

Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care.

The escalating costs of health care and other recent trends have made health care decisions of great societal import, with decision-making responsibility often being transferred from practitioners to health economists, health plans, and insurers. Health care decision making increasingly is guided by evidence that a treatment is efficacious, effective-disseminable, cost-effective, and scientifically plausible. Under these conditions of heightened cost concerns and institutional-economic decision making, psychologists are losing the opportunity to play a leadership role in mental and behavioral health care: Other types of practitioners are providing an increasing proportion of delivered treatment, and the use of psychiatric medication has increased dramatically relative to the provision of psychological interventions. Research has shown that numerous psychological interventions are efficacious, effective, and cost-effective. However, these interventions are used infrequently with patients who would benefit from them, in part because clinical psychologists have not made a convincing case for the use of these interventions (e.g., by supplying the data that decision makers need to support implementation of such interventions) and because clinical psychologists do not themselves use these interventions even when given the opportunity to do so. Clinical psychologists' failure to achieve a more significant impact on clinical and public health may be traced to their deep ambivalence about the role of science and their lack of adequate science training, which leads them to value personal clinical experience over research evidence, use assessment practices that have dubious psychometric support, and not use the interventions for which there is the strongest evidence of efficacy. Clinical psychology resembles medicine at a point in its history when practitioners were operating in a largely prescientific manner. Prior to the scientific reform of medicine in the early 1900s, physicians typically shared the attitudes of many of today's clinical psychologists, such as valuing personal experience over scientific research. Medicine was reformed, in large part, by a principled effort by the American Medical Association to increase the science base of medical school education. Substantial evidence shows that many clinical psychology doctoral training programs, especially PsyD and for-profit programs, do not uphold high standards for graduate admission, have high student-faculty ratios, deemphasize science in their training, and produce students who fail to apply or generate scientific knowledge. A promising strategy for improving the quality and clinical and public health impact of clinical psychology is through a new accreditation system that demands high-quality science training as a central feature of doctoral training in clinical psychology. Just as strengthening training standards in medicine markedly enhanced the quality of health care, improved training standards in clinical psychology will enhance health and mental health care. Such a system will (a) allow the public and employers to identify scientifically trained psychologists; (b) stigmatize ascientific training programs and practitioners; (c) produce aspirational effects, thereby enhancing training quality generally; and (d) help accredited programs improve their training in the application and generation of science. These effects should enhance the generation, application, and dissemination of experimentally supported interventions, thereby improving clinical and public health. Experimentally based treatments not only are highly effective but also are cost-effective relative to other interventions; therefore, they could help control spiraling health care costs. The new Psychological Clinical Science Accreditation System (PCSAS) is intended to accredit clinical psychology training programs that offer high-quality science-centered education and training, producing graduates who are successful in generating and applying scientific knowledge. Psychologists, universities, and other stakeholders should vigorously support this new accreditation system as the surest route to a scientifically principled clinical psychology that can powerfully benefit clinical and public health.

Sexual coercion and the misperception of sexual intent.

Misperceiving a woman's platonic interest as sexual interest has been implicated in a sexual bargaining process that leads to sexual coercion. This paper provides a comprehensive review of sexual misperception, including gender differences in perception of women's sexual intent, the relationship between sexual coercion and misperception, and situational factors that increase the risk that sexual misperception will occur. Compared to women, men consistently perceive a greater degree of sexual intent in women's behavior. However, there is evidence to suggest that this gender effect may be driven largely by a sub-group of men who are particularly prone to perceive sexual intent in women's behavior, such as sexually coercive men and men who endorse sex-role stereotypes. Situational factors, such as alcohol use by the man or woman, provocative clothing, and dating behaviors (e.g., initiating the date or making eye contact), are all associated with increased estimates of women's sexual interest. We also critique the current measurement strategies and introduce a model of perception that more closely maps on to important theoretical questions in this area. A clearer understanding of sexual perception errors and the etiology of these errors may serve to guide sexual-assault prevention programs toward more effective strategies.

Heterosocial perceptual organization: application of the choice model to sexual coercion.

Luce's (1959, 1963) choice model was used to characterize individual differences in men's perception of women's affect as friendly, sexually interested, sad, or rejecting. Women's clothing styles were associated with differences in the model's parameters. Sensitivity to sadness, rejection, and friendliness declined when women were dressed provocatively, whereas sensitivity to sexual interest increased. Provocative clothing was also associated with an increased bias to assume that positive affect was sexual interest rather than friendliness. Men at risk for perpetrating sexual aggression were less sensitive to women's affect than low-risk men were. They were also more likely than low-risk men to associate provocative clothing with sexual interest, and conservative clothing with friendliness. Results indicate that heterosocial perception may help to predict sexually coercive behavior and may be an important target for intervention.

Doctoral training in clinical psychology.

Competing models of doctoral training in clinical psychology are described and compared within their historical contexts. Trends in the field are examined critically with a focus on the impact of managed care on doctoral training and clinical practice. Implications for the future of doctoral training are considered, and a blueprint for the future of doctoral training in clinical psychology is presented.

Theory and utility--key themes in evidence-based assessment: comment on the special section.

This article focuses on two key themes in the four featured reviews on evidence-based assessment. The first theme is the essential role of theory in psychological assessment. An overview of this complex, multilayered role is presented. The second theme is the need for a common metric with which to gauge the utility of specific psychological tests and measures for specific purposes. A metric from information theory is recommended. The implications of these themes for the four reviews and for the future of psychological assessment in general are discussed.

Illusory correlation for body type and happiness: covariation bias and its relationship to eating disorder symptoms.

OBJECTIVE: The current study investigates covariation bias (illusory correlation) in the perceived association between happiness and body type, as well as the association between covariation bias and eating disorder symptoms. METHOD: Undergraduate women (n = 186) rated pictures of women on a variety of attributes, including happiness, degree of overweight, and attractiveness. Later, they were asked to judge the level of covariation between these attributes that was present in the stimuli that they had rated. Participants also completed the Eating Disorder Examination-Self-Report Questionnaire (EDE-Q). RESULTS: Participants reported that there was a negative association between weight and happiness in the stimuli that they had rated, even though the true correlation in the data was zero. This covariation bias was stronger among participants with higher levels of eating disorder symptoms. DISCUSSION: The results suggest a cognitive bias that may play a role in maintaining and enhancing concerns about shape and weight in symptomatic women.

Effects of emotional valence and arousal manipulation on eyeblink classical conditioning and autonomic measures.

Using a classical eyeblink conditioning paradigm, we have previously shown that the rate of acquisition of a conditioned response may be manipulated by engaging subjects in background tasks of varying complexity concurrent to conditioning. To further examine the influence of the background environment on conditioning, a picture set designed to elicit emotional responses, the International Affective Picture System (IAPS), was presented to subjects during classical eyeblink conditioning. The results suggest that eyeblink conditioning does appear to be sensitive to contextual manipulations of arousal. Pictures rated as very arousing were found to engage subjects enough to enhance learning, although not to the point that autonomic functions were significantly altered between picture groups. We suggest that group differences in learning may be a result of either novelty of, or vigilance to, interesting pictures rather than as a direct result of physiological arousal.

Modeling individual differences in perceptual and attentional processes related to bulimic symptoms.

Attentional and perceptual differences between women with high and low levels of bulimic symptoms were studied with techniques adapted from cognitive science. Stimuli were pictures of young women varying in body size and facial affect. A multidimensional scaling analysis showed that the high-symptom women were significantly more attentive to information about body size and significantly less attentive to information about affect. In prototype classification tasks, the high-symptom women used significantly more information about body size and significantly less information about affect. There were strong associations between individual differences in attention in the similarity task and decision making in the classification tasks. The study shows the potential utility of cognitive science methods for the study of cognitive factors in psychopathology.

Assessing clinically relevant perceptual organization with multidimensional scaling techniques.

Multidimensional scaling (MDS) techniques provide a promising measurement strategy for characterizing individual differences in cognitive processing, which many clinical theories associate with the development, maintenance, and treatment of psychopathology. The authors describe the use of deterministic and probabilistic MDS techniques for investigating numerous aspects of perceptual organization, such as dimensional attention, perceptual correlation, within-attribute organization, and perceptual variability. Additionally, they discuss how formal quantitative models can be used, in conjunction with MDS-derived representations of individual differences in perceptual organization, to test theories about the role of cognitive processing in clinically relevant phenomena. They include applied examples from their work in the areas of eating disorders and sexual coercion.

Training for prescriptions vs. prescriptions for training: where are we now? Where should we be? How do we get there?

The proposal that state legislatures should grant prescription privileges to psychologists is examined critically, with particular attention to the proposal's implications for the future education and training of clinical psychologists. First, the current status of clinical psychology is described. Then, an alternative to the prescription privilege proposal is presented; this alternative prescribes a scientific approach to clinical psychology. Finally, a plan for achieving this alternative is outlined.