On the dissemination of clinical experiences in using empirically supported treatments.

This article addresses the long-standing gap that has existed between psychotherapy research and practice and the efforts that have been made to bridge it. It also introduces one such effort, which has consisted of 3 clinical surveys on the experiences of practitioners in using empirically supported treatments for panic disorder, social anxiety, and OCD. In contrast to attempts to close the gap by disseminating research findings to the clinician, the clinical surveys are intended to allow for practitioners to disseminate their clinical experiences to the researcher-and also to other clinicians. What we view as a "two-way bridge" initiative is a collaboration between the Society of Clinical Psychology, Division 12 of the APA, and the Psychotherapy Division of the APA-Division 29. The mechanism that has been established provides a way for clinicians to be a part of the research process, which we hope will provide evidence that can help to enhance our clinical effectiveness.

Clinical experiences in using cognitive-behavior therapy to treat panic disorder.

Although there is a growing body of research to support the use of psychological treatments for specific disorders, there has been no way for practitioners to provide feedback to researchers on the barriers they encounter in implementing these treatments in their day-to-day clinical work. In order to provide practitioners a means to give researchers information about their clinical experience, the Society of Clinical Psychology and the Division of Psychotherapy of the American Psychological Association collaborated on an initiative to build a two-way bridge between practice and research. A questionnaire was developed on the therapist, patient, and contextual variables that undermine the effective use of CBT in reducing the symptoms of panic disorder, a clinical problem that occurs frequently in clinical practice and has an extensive research base. An Internet-based survey was advertised internationally in listservs and professional newsletters, asking clinicians to indicate all aspects of CBT that they used in treating panic disorder, and to respond to a series of questions with variables that presumably limited successful symptom reduction in clinical work using CBT to treat panic disorder. The final database included responses from 338 participants who varied in experience in applying CBT to the treatment of panic disorders. Participants identified a wide range of patient factors that were barriers to symptom reduction, including symptoms related to panic, motivation, social system, and the psychotherapy relationship, in addition to specific problems with implementing CBT for the treatment of panic disorder.

Internet and video technology in psychotherapy supervision and training.

The seven articles in this special section on the use of Internet and video technology represent the latest growth on one branch of the increasingly prolific and differentiated work in the technology of psychotherapy. In addition to the work presented here on video and the Internet applications to supervision and training, information technology is changing the field of psychotherapy through computer assisted therapies and virtual reality interventions.

Higher infant blood lead levels with longer duration of breastfeeding.

OBJECTIVE: To determine whether longer breastfeeding is associated with higher infant lead concentrations. STUDY DESIGN: Data were analyzed from 3 studies of developmental effects of iron deficiency in infancy: Costa Rica (1981-1984), Chile (1991-1996), and Detroit (2002-2003). The relation between duration of breastfeeding and lead levels was assessed with Pearson product-moment or partial correlation coefficients. RESULTS: More than 93% of the Costa Rica and Chile samples was breastfed (179 and 323 breastfed infants, respectively; mean weaning age, 8-10 months), as was 35.6% of the Detroit sample (53 breastfed infants; mean weaning age, 4.5 months). Lead concentrations averaged 10.8 microg/dL (Costa Rica, 12-23 months), 7.8 microg/dL (Chile, 12 months), and 2.5 microg/dL (Detroit, 9-10 months). Duration of breastfeeding as sole milk source and total breastfeeding correlated with lead concentration in all samples (r values = 0.14-0.57; P values = .06-<.0001). CONCLUSIONS: Longer breastfeeding was associated with higher infant lead concentration in 3 countries, in 3 different decades, in settings differing in breastfeeding patterns, environmental lead sources, and infant lead levels. The results suggest that monitoring lead concentrations in breastfed infants be considered.

Questioning the measurement precision of psychotherapy research.

Recent developments in psychometric theory have important implications for the development and validation of the instruments used in psychotherapy research. This article illustrates how the advances in latent trait and item response theory (IRT) have distinct advantages over classical test theory. The basic assumptions of IRT (unidimensionality, local independence, and monotonicity) and the concepts common to all four of the basic IRT models (item characteristic curve, item information function, and test information function) are reviewed. IRT methods are illustrated using responses to a psychotherapy outcome instrument from a large data set of a commercial health plan.

Comment: Can clinical judgment hold its own against scientific knowledge? Comment on Zeldow (2009).

P. B. Zeldow (2009) presents a series of vignettes that make a compelling case for the role of clinical judgment and for the claim that the knowledge of a credentialed practitioner stand up against the credentialed knowledge of scientific research. This comment discusses how the dispute between scientific knowledge and clinical judgment is not unique to psychotherapy but has been extensively discussed in other disciplines, especially medicine and education. Two models of science and practice are presented: a model based on Aristotle's (1999) distinction between techne and phronesis and H. L. Dreyfus and S. E. Dreyfus's (1986) five-stage model of skill acquisition. Both a scientific knowledge base and a model of clinical practice that value the judgment of the expert practitioner are necessary for psychology to be a learned profession. Nevertheless, the gap between science and practice may never be fully closed but will always have irresolvable conflicts that can only be contained. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Effects of iron therapy on infant blood lead levels.

OBJECTIVES: To determine the effects of iron therapy on blood lead levels in infants with mildly elevated lead levels and varied iron status. METHODS: Infants from a community-derived sample in Costa Rica were categorized into five groups. Group 1 had iron-deficiency anemia with hemoglobin levels

Maternal depression in three Latin American samples.

BACKGROUND: The purposes of the present study were: 1) to assess the prevalence of depressive symptoms in mothers of young children in two Latin American countries (Costa Rica and Chile), and 2) to identify and compare socio-demographic correlates of depressive symptoms among those women. METHODS: Information on maternal depression and socio-demographic factors was available for three samples of women (total n = 1256). The samples were drawn from periurban communities that were relatively homogeneous with respect to lower-middle-class status and ethnic origin. Point prevalence of depressive symptomatology was assessed using the Center for Epidemiological Studies - Depression scale in all three samples. Lifetime prevalence of major depressive episodes was assessed in two Costa Rican samples by the Diagnostic Interview Schedule. Finally, episodes of dysphoric mood following childbirth were assessed by interview in the Costa Rican samples. RESULTS: Although the three samples differed on nearly all socio-demographic measures, rates of depression were comparable - 35% to 50% of the mothers had experienced at least one episode of major depression or were experiencing severe dysphoric mood at the time of the evaluation. In addition, one-third of the Costa Rican mothers had experienced dysphoric mood following delivery of a child. CONCLUSIONS: The present study indicates that the high prevalence of depression in the mothers of young children is present in developing as well as industrialized countries and represents a major public health hazard. Future cross-cultural studies of maternal depression will require methodologies that are sensitive both to contextual factors in which depressive affect is expressed and individual histories that follow the course and etiology of depressive disorders as a chronic, recurrent illness in women during the childbearing and child-rearing years.