The key components of a clinical psychology formulation: A consensus study.

OBJECTIVE: Psychological formulation is a key competency for clinical psychologists. However, there is a lack of consensus regarding the key components and processes of formulation that are hypothesized to contribute to poor reliability of formulations. The aim of this study was to develop consensus on the essential components of a formulation to inform training for clinical psychologists and best practice guidelines. METHODS: A Delphi methodology was used. Items were generated from the literature and discussed and refined with a panel of experts (n = 10). In round one, 110 clinical psychologists in the United Kingdom rated the importance of components of formulation via an online questionnaire. Criteria for consensus were applied and statements were rerated in round two if consensus was not achieved. RESULTS: Consensus was achieved on 30 items, with 18 statements regarding components of a formulation and 12 statements regarding formulation process. Items that clinicians agreed upon emphasized the importance of integrating sociocultural, biological, strengths and personal meaning alongside well-established theoretical frameworks. Consensus was not reached on 20 items, including whether a formulation should be parsimonious or adhere to a model. CONCLUSION: Our findings provide mixed evidence regarding consensus on the key components of formulation. There was an agreement that formulation should be client-led and incorporate strengths and sociocultural factors. Further research should explore client perspectives on the key components of formulation and how these compare to the clinicians' perspectives.

Escuchando al placebo, o cómo averiguar por qué funcionan los tratamientos / Listening to the placebo, or how to find out why treatments work

El efecto placebo es poderoso y ha demostrado su eficacia en múltiples estudios, compitiendo incluso con tratamientos bien establecidos. Esto pone de manifiesto un efecto en absoluto inerte o inespecífico. Tiene una naturaleza ubicua y da razón de todo tipo de tratamientos, si bien es la psicología el ámbito que le hace comprensible. Desgranar y conocer qué le hace tan eficaz es una tarea útil e ilustrativa de cómo operan los tratamientos al uso. En este sentido hay que destacar que para que opere debe ser construido en términos contextuales, no requiere de engaños y sí de una persona con problemas, en desequilibrio homeostático. El estudio de las condiciones en que el efecto placebo ocurre ha sido útil para delinear qué aspectos son importantes en los tratamientos, a saber: la facilitación de información y el sentido de ésta, las experiencias previas y las creencias del paciente, la aplicación del tratamiento en condiciones favorables y el uso de tratamientos bien reconocidos y aceptados en sus fundamentos y procedimiento

The placebo effect is powerful and has been proved effective in multiple studies, competing even with well-established treatments. It is not an unspecific or inert effect. It has a ubiquitous nature and accounts for all types of treatments, although psychology is the area that makes it comprehensible. Discussing and discovering what makes it so effective is a useful and illustrative task regarding how treatments work. In this sense, it must be emphasized that in order for the placebo effect to operate, it must be considered from contextual view, it does not require deception, and it does require a person with problems, in homeostatic imbalance. The study of the conditions in which the placebo effect occurs has been useful in delineating which aspects are important in treatments. These are as follows: the provision of information and its meaning, the patient's previous experiences and beliefs, the application of the treatment under favorable conditions, and the use of well-recognized and accepted treatments in their foundations and procedure

Accounting for Confounding in Observational Studies.

The goal of this review is to enable clinical psychology researchers to more rigorously test competing hypotheses when studying risk factors in observational studies. We argue that there is a critical need for researchers to leverage recent advances in epidemiology/biostatistics related to causal inference and to use innovative approaches to address a key limitation of observational research: the need to account for confounding. We first review theoretical issues related to the study of causation, how causal diagrams can facilitate the identification and testing of competing hypotheses, and the current limitations of observational research in the field. We then describe two broad approaches that help account for confounding: analytic approaches that account for measured traits and designs that account for unmeasured factors. We provide descriptions of several such approaches and highlight their strengths and limitations, particularly as they relate to the etiology and treatment of behavioral health problems.

Psicología Clínica en Atención Primaria: la experiencia en Asturias / Clinical Psychologist in Primary Care: the work carried out in Asturias

OBJETIVO: Describir las características de la población atendida en el programa de psicología clínica en Atención Primaria, así como realizar un análisis preliminar de los resultados obtenidos. MÉTODO: Estudio descriptivo prospectivo de los resultados obtenidos tras intervención psicológica breve. Se utilizaron los instrumentos de evaluación PHQ-9, GAD-7, WHOQOL-BREF y un cuestionario de satisfacción diseñado ad hoc. RESULTADOS: Se derivaron al programa 1.084 pacientes, en su mayoría mujeres. Los diagnósticos más frecuentes fueron ansiedad, trastornos adaptativos, códigosZ (factores que influyen en el estado de salud y contacto con los servicios de salud) y trastornos depresivos. El tiempo de espera medio se sitúa en 7,25 días, y el número medio de consultas, en 3. En la comparación al inicio y tras la finalización del tratamiento se encontró una mejora estadísticamente significativa en todas las variables evaluadas, así como una alta satisfacción y utilidad del tratamiento. CONCLUSIONES: La integración del psicólogo clínico en Atención Primaria supone una mejora en la calidad asistencial de los pacientes con alteraciones emocionales, facilitando un abordaje interdisciplinar bio-psico-social y ofreciendo tratamientos e intervenciones basadas en la evidencia y recomendadas internacionalmente

AIM: To describe the characteristics of the population attended in the clinical psychology programme in Primary Care, as well as to perform a preliminary analysis of the results obtained. METHOD: Prospective, descriptive study of the results obtained after brief psychological intervention. The following evaluation tools were used: PHQ-9, GAD-7, WHOQOL-BREF, and an ad hoc designed satisfaction questionnaire. RESULTS: A total of 1084 patients were referred to the program, and were mostly women. The most frequent diagnoses were anxiety, adaptive disorders, Zcodes (factors that influence the state of health and contact with health services) and depressive disorders. The mean waiting list time was 7.25 days, and the mean number of consultations was3. The analyses performed after the treatment showed an improvement in all the variables evaluated, as well as high satisfaction and usefulness of the treatment. CONCLUSIONS: The integration of the clinical psychologist in Primary Care leads to an improvement in the quality of care of patients with emotional disorders, facilitating an interdisciplinary bio-psycho-social approach, and offering internationally recommended evidence-based treatments and interventions

Consensus-based good practice guidelines for clinical psychologists to support care staff in enabling sexual expression in people with intellectual disabilities-A Delphi study.

BACKGROUND: Care staff supporting people with intellectual disabilities (PWID) report accepting views on PWID's sexual expression, but people with intellectual disabilities report their sexual expression is restricted by care staff. METHODS: We recruited a panel of 17 UK clinical psychologists experienced in helping care staff support PWID's sexual expression. We used the Delphi Method to develop consensus-based practice guidelines for UK clinical psychologists supporting care staff in this way. RESULTS: Having proposed three guidelines each in Round One, panel members reached consensus (≥90% agreement) that 12 were important, falling under four themes: "Addressing staff attitudes," "Addressing uncertainty about rights and responsibilities of people with intellectual disabilities," "Locating the problem, being part of the solution," and "Supporting care staff to understand and reflect upon their role." CONCLUSIONS: Clinical psychologists help care staff support PWID's sexual expression by normalizing care staff concerns, encouraging reflection, clarifying PWID's rights, and prompting those at managerial and service level to support care staff.

Evolution of clinical neuropsychology: Four challenges.

Quantitative and evidence-based approaches fail to capture "the whole person," neglect the important contributions of nonquantitative variables to understanding behavior, and have limitations when assessing individuals who fall outside traditional normative groups. The emphasis on quantitative and evidence-based practices is one challenge facing the profession. The lack of consensual definitions for various domains of interest is a second challenge, because it hinders research, poses communication challenges, and impedes the accumulation of knowledge about human behavior. A third challenge the profession faces is an overemphasis on the biological basis of behavior. Finally, the forth challenge is the impact of technology on practice. Since the 1970s, there has been a rapid advance in our ability to investigate the brain, resulting in a significant increase of information about brain functioning, making it difficult for clinicians to stay abreast of changes in the field. Advances in technology have resulted in "assessments" being completed by nonpsychologists. To place these and related challenges in context, a brief review of the history of assessment and efforts to investigate brain functioning will be presented. It is suggested that failure to meet these challenges will contribute to the demise of the profession. Suggestions for meeting these challenges are offered.

[Clinical Psychologist in Primary Care: The work carried out in Asturias]. / Psicología Clínica en Atención Primaria: la experiencia en Asturias.

AIM: To describe the characteristics of the population attended in the clinical psychology programme in Primary Care, as well as to perform a preliminary analysis of the results obtained. METHOD: Prospective, descriptive study of the results obtained after brief psychological intervention. The following evaluation tools were used: PHQ-9, GAD-7, WHOQOL-BREF, and an ad hoc designed satisfaction questionnaire. RESULTS: A total of 1084 patients were referred to the program, and were mostly women. The most frequent diagnoses were anxiety, adaptive disorders, Zcodes (factors that influence the state of health and contact with health services) and depressive disorders. The mean waiting list time was 7.25days, and the mean number of consultations was3. The analyses performed after the treatment showed an improvement in all the variables evaluated, as well as high satisfaction and usefulness of the treatment. CONCLUSIONS: The integration of the clinical psychologist in Primary Care leads to an improvement in the quality of care of patients with emotional disorders, facilitating an interdisciplinary bio-psycho-social approach, and offering internationally recommended evidence-based treatments and interventions.

Review of "Common Factors," Personal Reflections, and Introduction of the Shaving Brush Model of Integrated Psychotherapies.

This column reviews and updates "common factors" in psychotherapy, as originally described by Saul Rosenzweig in 1936. The author, a psychiatrist who has used multiple modalities of psychotherapeutic treatment over 4 decades, shares personal reflections concerning these "common factors" and introduces a model of integrated psychotherapies named for his grandfather's shaving brush.

Introduction to the special section on increasing replicability, transparency, and openness in clinical psychology.

As psychological research comes under increasing fire for the crisis of replicability, attention has turned to methods and practices that facilitate (or hinder) a more replicable and veridical body of empirical evidence. These trends have focused on open science initiatives, including an emphasis on replication, transparency, and data sharing. Despite this broader movement in psychology, clinical psychologists and psychiatrists have been largely absent from the broader conversation on documenting the extent of existing problems as well as generating solutions to problematic methods and practices in our area (Tackett et al., 2017). The goal of the current special section was to bring together psychopathology researchers to explore these and related areas as they pertain to the types of research conducted in clinical psychology and allied disciplines. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An N-pact factor for clinical psychological research.

Although an emphasis on adequate sample size and statistical power has a long history in clinical psychological science (Cohen, 1992), increased attention to the replicability of scientific findings has renewed focus on the importance of statistical power (Bakker, van Dijk, & Wicherts, 2012). These recent efforts have not yet circled back to modern clinical psychological research, despite the importance of sample size and power in producing a credible body of evidence. As one step in this process of scientific self-examination, the present study estimated an N-pact Factor (the statistical power of published empirical studies to detect typical effect sizes; Fraley & Vazire, 2014) in 2 leading clinical journals (the Journal of Abnormal Psychology [JAP] and the Journal of Consulting and Clinical Psychology [JCCP]) for the years 2000, 2005, 2010, and 2015. Study sample size, as one proxy for statistical power, is a useful focus because it allows comparisons with other subfields and may highlight some of the core methodological differences between clinical and other areas. We found that, across all years examined, the average median sample size in clinical research was 179 participants (175 for JAP and 182 for JCCP). The power to detect a small to medium effect size of .20 is just below 80% for both journals. Although the clinical N-pact factor was higher than that estimated for social psychology, the statistical power in clinical journals is still limited to detect many effects of interest to clinical psychologists, with little evidence of improvement in sample sizes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluating the evidential value of empirically supported psychological treatments (ESTs): A meta-scientific review.

Empirically supported treatments (or therapies; ESTs) are the gold standard in therapeutic interventions for psychopathology. Based on a set of methodological and statistical criteria, the APA has assigned particular treatment-diagnosis combinations EST status and has further rated their empirical support as Strong, Modest, and/or Controversial. Emerging concerns about the replicability of research findings in clinical psychology highlight the need to critically examine the evidential value of EST research. We therefore conducted a metascientific review of the EST literature, using clinical trials reported in an existing online APA database of ESTs, and a set of novel evidential value metrics (i.e., rates of misreported statistics, statistical power, R-Index, and Bayes Factors). Our analyses indicated that power and replicability estimates were concerningly low across almost all ESTs, and individually, some ESTs scored poorly across multiple metrics, with Strong ESTs failing to continuously outperform their Modest counterparts. Lastly, we found evidence of improvements over time in statistical power within the EST literature, but not for the strength of evidence of EST efficacy. We describe the implications of our findings for practicing psychotherapists and offer recommendations for improving the evidential value of EST research moving forward. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The registration continuum in clinical science: A guide toward transparent practices.

Clinical scientists can use a continuum of registration efforts that vary in their disclosure and timing relative to data collection and analysis. Broadly speaking, registration benefits investigators by offering stronger, more powerful tests of theory with particular methods in tandem with better control of long-run false positive error rates. Registration helps clinical researchers in thinking through tensions between bandwidth and fidelity that surround recruiting participants, defining clinical phenotypes, handling comorbidity, treating missing data, and analyzing rich and complex data. In particular, registration helps record and justify the reasons behind specific study design decisions, though it also provides the opportunity to register entire decision trees with specific endpoints. Creating ever more faithful registrations and standard operating procedures may offer alternative methods of judging a clinical investigator's scientific skill and eminence because study registration increases the transparency of clinical researchers' work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Using implementation science to close the gap between the optimal and typical practice of quantitative methods in clinical science.

Quantitative methods remain the fundamental approach for hypothesis testing, but in approaches to data analysis there is substantial evidence of a gap between what is optimal and what is typical. It is clear that diffusion and dissemination alone are not maximally effective at improving data analytic practices in clinical psychological science. Amid declines in quantitative psychology training, and growing demand for advanced quantitative methods, applied researchers are increasingly called upon to conduct and evaluate research using methods in which they lack expertise. This "research-to-practice" gap in which rigorously developed and empirically supported quantitative methods are not applied in practice has received little attention. In this article, we describe how implementation science, which aims to reduce the research-to-practice gap in health care, offers a promising set of methods for closing the gap for quantitative methods. By identifying determinants of practice (i.e., barriers and facilitators of change), implementation strategies can be selected to increase adoption and high-fidelity application of new quantitative methods to improve scientific inferences and policy and practice decisions in clinical psychological science. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Utility of Event-Related Potentials in Clinical Psychology.

Event-related potentials (ERPs) are direct measures of brain activity that can be leveraged for clinically meaningful research. They can relate robustly both to continuous measures of individual difference and to categorical diagnoses in ways that clarify similarities and distinctions between apparently related disorders and traits. ERPs can be linked to genetic risk, can act as moderators of developmental trajectories and responses to stress, and can be leveraged to identify those at greater risk for psychopathology, especially when used in combination with other neural and self-report measures. ERPs can inform models of the development of, and risk for, psychopathology. Finally, ERPs can be used as targets for existing and novel interventions and prevention efforts. We provide concrete examples for each of these possibilities by focusing on programmatic research on the error-related negativity and anxiety, and thus show that ERPs are poised to make greater contributions toward the identification, prediction, treatment, and prevention of mental disorders.

Psychology's Replication Crisis and Clinical Psychological Science.

Despite psychological scientists' increasing interest in replicability, open science, research transparency, and the improvement of methods and practices, the clinical psychology community has been slow to engage. This has been shifting more recently, and with this review, we hope to facilitate this emerging dialogue. We begin by examining some potential areas of weakness in clinical psychology in terms of methods, practices, and evidentiary base. We then discuss a select overview of solutions, tools, and current concerns of the reform movement from a clinical psychological science perspective. We examine areas of clinical science expertise (e.g., implementation science) that should be leveraged to inform open science and reform efforts. Finally, we reiterate the call to clinical psychologists to increase their efforts toward reform that can further improve the credibility of clinical psychological science.

American Psychological Association practice guidelines for psychopharmacology: Ethical practice considerations for psychologists involving psychotropic use with children and adolescents.

OBJECTIVES: This study discusses the implications of the American Psychological Association's 2011 Practice Guidelines for Pharmacology as they apply to psychologists working with juvenile clients. Special considerations apply due to concerns about the developmental side effects that occur when psychotropic medications are prescribed to children and adolescents. METHODS OR DESIGN: This study provides recommendations for implementing each of the Practice Guidelines. Constructive criticism of the Practice Guidelines is also discussed with the aim of improving service delivery. RESULTS: This study provides specific recommendations for psychologists regarding obtaining adequate knowledge about psychopharmacology to inform clients or consult with physicians. Suggestions are made for continuing education requirements for psychologists who work with juveniles. CONCLUSIONS: Recommendations are made for psychologists working with juveniles to increase their knowledge of psychotropic medications for a more ethical and informed voice regarding the prescribing of such medications.

Clinical supervision-the missing ingredient.

Clinical supervision is acknowledged as a distinct professional competence that requires specific education and training. However, it is all too often an inadequately addressed or an entirely missing ingredient in psychology curricula and clinical research, including, for example, clinical trial protocols and evidence-based treatment implementation. It is proposed that clinical supervision training follow the shift to the competence movement that has occurred in psychology education, training, and regulation generally and embrace a systematic and intentional competence model. Groundwork for such a competence model for supervision has been laid in the supervision guidelines from the American Psychological Association and the Association of State and Provincial Psychology Boards, defining parameters for clinical supervision and the requisite supervisor competencies. This article discusses these inadequately addressed or missing ingredients, the insufficiently organized approach to supervision as a distinct competency at the present time, and the assumptions that are obstacles to progress. Strategies are proposed to overcome these obstacles; for example, methods of infusing supervision into existing curricula, the hidden curriculum, and transformational leadership that would guide its implementation. Knowledge, skills, and attitudes would be systematically developed as a critical component of self-reflective competency-based education, a portal to lifelong learning, and an essential part of research and implementation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Una Extensión del Concepto de Regla y su Aplicación a la Terapia Psicológica / An extension of the concept of rule and its application to therapy

Proporcionar y seguir reglas se ha considerado un factor importante en la eficacia de los tratamientos psicológicos; sin embargo, hace falta una clarificación conceptual de lo que se entiende por emitir o seguir una regla y su aplicación en el ámbito clínico. Partiendo de una revisión sobre el concepto original de conducta gobernada por reglas, nuestro propósito fue extender la definición de esta conducta orientada al proceso terapéutico. Esta definición permite su identificación y estudio momento a momento a lo largo del proceso. La extensión de esta definición puede ayudarnos a identificar el papel funcional de las reglas en el cambio terapéutico y las variables involucradas que contribuyen al entendimiento de fenómenos clínicos como la generalización. Los hallazgos que se desprendan del estudio de las reglas desde esta perspectiva podrían contribuir a aumentar la información sobre el proceso de cambio terapéutico y la mejora del ejercicio clínico

Providing and following rules has been considered an important factor in the effectiveness of psychological treatments; however, a conceptual clarification is needed of what is meant by issuing or following a rule and its application in the clinical setting. Based on a review of the original concept of rule-governed behavior, our purpose was to extend the definition of this behavior oriented to the clinical process. This definition allows its identification and study moment by moment throughout the therapeutic process. The extension of this definition can help us to identify the al role of rules in clinical change and the variables involved that contribute to the understanding of clinical phenomena such as generalization. The findings that emerge from the study of rules from this perspective could increase the information on the therapeutic change process and, therefore, contribute to the improvement of clinical practice

Psicoterapia: marca registrada / Psychotherapy: trademark

En este trabajo se discute acerca de la excesiva proliferación de diferentes tipos de psicoterapia y el negocio construido alrededor de los mismos: métodos patentados, cursos, acreditaciones oficiales, libros, etcétera. Se muestra cómo la evidencia científica no justifica la práctica habitual de privilegiar el tipo de tratamiento concreto que se utiliza en terapia sobre otras variables que han demostrado ser más relevantes, especialmente aquellas asociadas a la relación terapéutica y a los factores vinculados a terapeuta y paciente. Finalmente, se plantea la necesidad de abandonar la competición entre modelos y centrar la investigación en aquellos factores que hacen de la psicoterapia un procedimiento eficaz para solucionar problemas de salud mental, más allá de la marca (paradigma) del tratamiento empleado

In this paper we discuss the excessive proliferation of different types of psychotherapy and the business built around them: patented methods, courses, official accreditations, books, etcetera. It is shown how the scientific evidence does not justify the usual practice of favouring the specific type of therapy that is used in treatment over other variables that have been shown to be more relevant; especially, those associated with the therapeutic relationship and other factors related to therapist and patient. Finally, we point out the need to abandon the competition among models and propose that research focuses on those factors that account for the effectiveness of psychotherapy as a procedure to solve mental health problems, beyond the mark (paradigm) of the treatment used

A systematic review of team formulation in clinical psychology practice: Definition, implementation, and outcomes.

PURPOSE: Team formulation is promoted by professional practice guidelines for clinical psychologists. However, it is unclear whether team formulation is understood/implemented in consistent ways - or whether there is outcome evidence to support the promotion of this practice. This systematic review aimed to (1) synthesize how team formulation practice is defined and implemented by practitioner psychologists and (2) analyse the range of team formulation outcomes in the peer-reviewed literature. METHODS: Seven electronic bibliographic databases were searched in June 2016. Eleven articles met inclusion criteria and were quality assessed. Extracted data were synthesized using content analysis. RESULTS: Descriptions of team formulation revealed three main forms of instantiation: (1) a structured, consultation approach; (2) semi-structured, reflective practice meetings; and (3) unstructured/informal sharing of ideas through routine interactions. Outcome evidence linked team formulation to a range of outcomes for staff teams and service users, including some negative outcomes. Quality appraisal identified significant issues with evaluation methods; such that, overall, outcomes were not well-supported. CONCLUSIONS: There is weak evidence to support the claimed beneficial outcomes of team formulation in practice. There is a need for greater specification and standardization of 'team formulation' practices, to enable a clearer understanding of any relationships with outcomes and implications for best-practice implementations. PRACTITIONER POINTS: Under the umbrella term of 'team formulation', three types of practice are reported: (1) highly structured consultation; (2) reflective practice meetings; and (3) informal sharing of ideas. Outcomes linked to team formulation, including some negative outcomes, were not well evidenced. Research using robust study designs is required to investigate the process and outcomes of team formulation practice.