Bridging scientist and practitioner perspectives in clinical psychology

The Promise and Challenges of Practice-Oriented Research: A Commentary on the Special Issue

At the centre of POR is the concept of collaboration between patients, therapists, agencies, and third-party payers. For this commentary, I review the articles of the special issue with attention to both the opportunities and challenges offered by practice-oriented research (POR). I also reviewed some previous research on practice-research networks and how that research might inform POR. The use of routine outcome monitoring (ROM), artificial intelligence (AI), and program evaluation (PE) models show promise for advancing POR. However, each comes with its challenges. The use of ROM to improve patient outcomes has research support. However, researchers have identified problems with implementing ROM because of low uptake by clinicians and because clinicians may see ROM as a potential intrusion. AI shows promise to improve patient outcomes by potentially providing therapists with immediate and nuanced data to inform interventions and interpersonal stances specific to each patient. However, the scaling up of AI runs the risk of dehumanizing psychological interventions. PE may provide a context for allowing therapists to engage in POR to address real-world processes and outcomes of mental health interventions. However, like ROM PE faces the challenge of trust among clinicians and patients who may be reluctant to participate. Despite these challenges, and because of efforts to nurture and maintain respectful collaborations, articles in this special issue highlight how POR can play a pivotal role in bridging the gap between theory and practice.

They Saw It Coming: Rising Trends in Depression, Anxiety, and Suicidality in Creative Students and Potential Impact of the COVID-19 Crisis

Previous research has established that creative adolescents are generally low in neuroticism and as well-adjusted as their peers. From 2006 to 2013, data from cohorts of creative adolescents attending a counseling laboratory supported these results. Clinical findings of increased anxiety, depression, and suicidality among creative students in 2014 led the researchers to create 3 studies to explore these clinical findings. Once artifactual causes of these changes were ruled out, a quantitative study was conducted. Study 1, an analysis of mean differences of pre-2014 and post-2014 cohorts showed that post-2014 cohorts scored significantly higher in Neuroticism, Openness to Experience, and Conscientiousness and lower in Extraversion on Big 5 inventories. Regression analyses suggested that while Neuroticism was associated with gender, Conscientiousness and Grade Point Average for the earlier group, Neuroticism in the post 2014 groups was related to complex interplay of all personality dynamics except Agreeableness. In the qualitative Study 2, focus groups of 6–10 students, for a total of 102 participants were queried about the reasons they perceived for increased anxiety and depression in creative students. Increased achievement pressures and awareness of environmental and social problems were major sources of external stressors; perfectionism and desire to fulfill expectations of others were the primary sources of internal stress. The authors suggest that creative students' openness to experience and advanced knowledge made it possible for these students to see the potential for environmental and social crises and respond to their inability to solve these problems with anxiety and depression. Study 3 was a qualitative study that followed up 19 participants from the post-2014 cohort to explore the impact of the COVID-19 pandemic on mental health and creativity. While the majority perceived a negative effect of the pandemic on their mental health, most also produced a surprising variety of creative works during that time. In conclusion, rapid changes in the lives of creative adolescents since 2014 suggest that scholars focus on current cohorts and the ways in which adolescent personality is shaped by internal expectation and external pressures and global events. Despite the pandemic, creative young people continued to create.

Exploring Perceived Interactions Between Consequences of Traumatic Brain Injury

OBJECTIVE

To explore the perceived interactions between consequences of traumatic brain injury (TBI).

PARTICIPANTS

Fifteen clinicians experienced in working with patients with TBI.

METHODS

Participating clinicians completed an online questionnaire in which they estimated the degree to which consequences of TBI (taken from the Brief ICF Core Set for Traumatic Brain Injury) causally relate to each other. Based on these perceived interactions, a visual network was constructed and centrality measures for this network were computed.

RESULTS

The resulting network demonstrates various strong perceived causal relations between the consequences of TBI. Impairments in consciousness were perceived to most strongly cause other TBI consequences in the network. Difficulties with acquiring, keeping, and terminating a job were perceived to be most strongly caused by other TBI consequences. Difficulties in partaking in complex interpersonal interactions were also perceived to play a central role in the network.

CONCLUSION

In the perception of clinicians, consequences of TBI interact with each other and are thus not solely a direct result of the injury. While more research is needed to map the interactions between consequences of TBI, our results could have important implications for the way we understand and treat the problems patients are faced with after TBI.

Clients' Experiences With Internet-Based Psychological Treatments for Mental Disorders: Protocol for a Metasynthesis of Qualitative Studies

BACKGROUND

Given the rise of internet-based treatments as an effective therapeutic tool for psychological disorders, it is necessary to carry out research that examines clients' experiences with this type of intervention. The qualitative methodology has been found to be useful for analyzing clients' perceptions in terms of facilitators and barriers, acceptability, and negative effects of internet-based treatments. However, a lack of integration of these primary studies has prevented their findings from being applied to new research and in clinical practice.

OBJECTIVE

The objective of this paper is to describe the protocol for a metasynthesis of qualitative studies exploring the experiences of clients who underwent an internet-based treatment.

METHODS

Elliot and Timulak's metasynthesis approach will be used to review and synthesize qualitative studies related to client experiences in terms of the barriers and facilitators they perceived when undergoing internet-based treatment. For each search string, the features in the Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) tool will be considered. Electronic databases (PubMed, PsycINFO, and Web of Science) will be searched. Two independent reviewers will analyze the material in order to determine whether the eligibility criteria are fulfilled. Findings will make it possible to create a hierarchy of domains in terms of their relevance across all the primary studies. The data obtained from primary studies will be cross-analyzed using descriptive and interpretative procedures.

RESULTS

The search strategy is currently being conducted. First results are expected to be submitted for publication in 2019.

CONCLUSIONS

We will develop conceptual framework of the barriers and facilitators perceived by clients and propose their implications and recommendations for clinical practice, research, and training.

TRIAL REGISTRATION

PROSPERO CRD42018079894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79894 (Archived by WebCite at http://www.webcitation.org/73C6OtlS7).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/9722.

Dynamic and Functional Approach to Human Memory in the Brain: A Clinical Neuropsychological Perspective

The way how cognition is conceived and represented in brain functioning will directly impact clinical investigations of people with cognitive difficulties. This is particularly evident in the field of clinical neuropsychology where methodologies and tools are justified on a fundamental level by the theoretical foundations adopted. The present article outlined how the dominant influences of structural and anatomo-clinical theories of memory have led to a particular conception of clinical investigations. We propose to reconsider these dominant methods in favor of a more dynamic and functional representation of memory that would be clinically more appropriate. More precisely, we argued that relying exclusively on a particular memory conception (i.e., structural) may not be sufficient considering the range of real-life variables affecting a patient’s memory. By extracting clinically meaningful information in more functional and dynamic memory conceptions, we also aim at underlining the potentials advantages of such theories in facilitating personalized assessments and follow up of patients in clinical neuropsychology. We suggest that a dynamic, functional, and integrative conception of memory would be more coherent with the trend in clinical neuropsychology to promote a more collaborative interaction between the clinician and the patient. Finally, considering the absence of empirical studies on the possible benefits of implementing such recent memory concepts in clinical practice, we encourage researchers and clinicians to test in the field of clinical neuropsychology, the usefulness and explanatory power of more dynamic and functional representation of memory in order to objectively demonstrate its validity outside the research loop.

Bridging the Gap Between Scientists and Practitioners: The Challenge Before Us - Republished Article

The need to develop effective and efficient strategies for the dissemination of evidence-based health care has been recognized by governments, researchers, and clinicians alike. However, recognition and implementation are separate issues. If scientists are to have a significant impact on clinical practice, they will have to learn a new way of "doing business." Lessons from the business community and from the field of diffusion of innovations research (dissemination research) have direct applicability to disseminating science-based clinical procedures. This paper presents two examples of the successful integration of science and clinical practice. The goal in each case was to address problems fundamental to dissemination research, specifically for addictions treatment. The first example demonstrates how scientists and practitioners successfully worked hand-in-hand to integrate science and practice, by creating a clinical protocol that subsequently served almost 300 clients. The second example describes the successful dissemination of a clinical research intervention into community settings. The key to effective dissemination was to make practitioners true partners in the research, development, and dissemination process. For the effective wedding of clinical science and practice on a wide scale, dissemination must be adopted as a value and become a major objective of health care organizations. Current health care emphasis on evidence-based practice suggests that alliances between practitioners and scientists will point the way to clinical standards of practice for the next millennium.

Community-Academic Partnership Participation

Community-academic partnerships (CAPs) improve the research process, outcomes, and yield benefits for the community and researchers. This exploratory study examined factors important in community stakeholders' decision to participate in CAPs. Autism spectrum disorder (ASD) community stakeholders, previously contacted to participate in a CAP (n = 18), completed the 15-item Decision to Participate Questionnaire (DPQ). The DPQ assessed reasons for participating or declining participation in the ASD CAP. CAP participants rated networking with other providers, fit of collaboration with agency philosophy, and opportunity for future training/consultations as factors more important in their decision to participate in the ASD CAP than nonparticipants. Nonparticipants reported the number of requests to participate in research as more important in their decision to decline participation than participants. Findings reveal important factors in community stakeholders' decision to participate in CAPs that may provide guidance on increasing community engagement in CAPs and help close the science-to-service gap.

The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations

This article provides an overview of the history of substance use and misuse and chronicles the long shared history humans have had with psychoactive substances, including alcohol. The practical and personal functions of substances and the prevailing views of society towards substance users are described for selected historical periods and within certain cultural contexts. This article portrays how the changing historical and cultural milieu influences the prevailing medical, moral, and legal conceptualizations of substance use as reflected both in popular opinion and the consensus of the scientific community and represented by the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, this article discusses the efforts to classify substance use disorders (SUDs) and associated psychopathology in the APA compendium. Controversies both lingering and resolved in the field are discussed, and implications for the future of SUD diagnoses are identified.

Research Self-Efficacy Beliefs and Research Outcome Expectations: Implications for Developing Scientifically Minded Psychologists

This article explores how and whether the empirical evidence pertaining to research self-efficacy beliefs and research outcome expectations can inform the training and development of scientifically minded psychologists. The competencies associated with a scientifically minded psychologist are described, and a summary and critique of the literature focused on research self-efficacy beliefs and research outcome expectations are presented. An assessment of whether these constructs are adequate for facilitating the development of scientifically minded psychologists is provided. Implications for future research directions are discussed.

Beyond Feelings:

Emotion and emotion-related processes lie at the heart of counseling, yet there is scant evidence that counseling psychology has a substantial curricular, scientific, or psychotherapeutic commitment to the psychological science of emotion. Likewise, social psychology and other fields involved with emotion science often avoid researching counseling-relevant topics and disseminate their findings in outlets and formats not likely to be accessed by or useful to counseling psychologists. This article identifies a series of impediments that may be responsible for these and related problems and proposes potential solutions.

Scientific Standards of Practice in School Psychology

This article challenges the discipline of school psychology to begin to ensure that scientific knowledge is actually used by practitioners. Topics and related issues and recommendations discussed include: the dialectics of science and practice; what is wanted from standards; standards as a basis of practice; how standards can be created; role of the practitioner in implementing standards; and some of the problems to be solved and pitfalls to be avoided. In essence, scientific standards of practice are examined as a method of linking practical psychological work to contemporary scientific knowledge.

Research Mentoring and Women in Clinical Psychology

The main question explored in this study is whether a woman's choice to do research during her career as a clinical psychologist is associated with having had a research mentor. A sample of 616 women, all members of the American Psychological Association holding a Ph.D. in Clinical Psychology, completed a survey about their experience with a research mentor. The data show that research mentoring is positively related to a woman in clinical psychology doing research and whether she, in turn, becomes a research mentor for others. The responses of the participants suggest that a model of mentoring that involves relevant training and practical experience in research may increase the likelihood that female clinical psychologists will choose to do research as part of their careers.

Behavioral Therapy Development and Psychological Science: Reinforcing the Bond

An abundance of research from diverse areas of psychological science is potentially relevant to behavioral therapy development research The National Institute on Drug Abuse of the National Institutes of Health convened a workshop to reinforce the connection between basic behavioral and therapy development research The articles in this Special Section are the product of this workshop Several lines of basic behavioral research are described, and implications for the development of behavioral therapies are discussed This Special Section highlights the notion that strengthening the bond between behavioral therapy development research and basic behavioral science will accelerate the advancement of knowledge about behavior, behavioral change and therapeutic interventions

Use of evidence-based assessment for childhood anxiety disorders in community practice

High-quality assessment is essential to the delivery of effective treatment for childhood anxiety disorders. However, relatively little is known about how frequently child clinicians utilize evidence-based assessment (EBA) techniques in practice, and even less is known about the factors that influence EBA use in such settings. Thus, the current study presents data from a survey of 339 clinicians from a variety of professional backgrounds concerning their use of EBA for childhood anxiety disorders and explores issues preventing EBA implementation. Results indicated infrequent EBA use with clinicians citing practical barriers (i.e., time, access, knowledge, cost) and negative beliefs about EBA techniques (i.e., unhelpful) as issues preventing implementation. Implications for future EBA dissemination and implementation efforts are discussed.

The gap between science and practice: how therapists make their clinical decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists' practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists' choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists' theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.

A Qualitative Investigation of Therapists' Attitudes towards Research: Horses for Courses?

BACKGROUND

A large body of research has identified that many therapists do not use research to inform their practice, but few studies investigate the reasons behind this.

AIMS

The current study seeks to understand what sources therapists use to inform their practice and why they are chosen.

METHOD

Thirty-three interviews with psychological therapists in the UK were undertaken. These were transcribed and analysed using Interpretative Phenomenological Analysis.

RESULTS

Two superordinate themes emerged. The former focused on the nature of evidence and the latter described why certain sources were used to make clinical decisions. When discussing evidence, participants felt that research studies, specifically Randomized Controlled Trials (RCTs), used unrepresentative samples. Therapists felt that research other than RCTs, particularly qualitative research, was important. Therapist specific factors were felt to be as, or more, important than the technique used to treat patients. When discussing the sources they used, therapists preferred to use their clinical experience or their patients' experience to make clinical decisions. Theoretical or practical information was preferred to empirical research. The presentation of information was felt to be important to encourage the implementation of research, and therapists also felt tools such as outcome measures and manuals were too rigid to be useful. Finally, patients' choice of treatment was felt to be important in treatment decisions.

CONCLUSIONS

The views of therapists were heterogeneous, but this study highlighted some of the barriers to closing the gap between science and practice. This knowledge can be used to increase the translation of science into practice.

Therapists and researchers: advancing collaboration

Collaborative partnerships between community-based clinicians and academic researchers have the potential to improve the relevance, utility, and feasibility of research, as well as the effectiveness of practice. Collaborative partnership research from a variety of fields can inform the development and maintenance of effective partnerships. In this paper we present a conceptual model of research-community practice partnership derived from literature across disciplines and then illustrate application of this model to one case example. The case example is a multi-year partnership between an interdisciplinary group of community-based psychotherapists and a team of mental health researchers. This partnership was initiated to support federally funded research on community-based outpatient mental health care for children with disruptive behavior problems, but it has evolved to drive and support new intervention studies with different clinical foci. Lessons learned from this partnership process will be shared and interpreted in the context of the presented research-practice partnership model.

Implementation issues in an innovative rural substance misuser treatment program

This article is essentially the story of the development, implementation, and testing of a treatment protocol designed specifically for rural individuals who are substance misusers. Although the treatment protocol that emerged from this process seemed to be valuable for clients, the researchers were not able to establish with statistical significance that it was better than conventional treatment. In some ways, this was a failure. This article explores some of the possible reasons why new treatment approaches, tested in real clinical situations, may have difficulty establishing their effectiveness. The factors involved are many and complex.

Psychotherapie und Wissenschaft

Klinische Praxis und Psychotherapieforschung werden häufig als Spannungsfelder mit wenigen Berührungspunkten angesehen. Trotz erheblicher empirischer Erkenntnisgewinne über die letzten Jahrzehnte hinweg spielen in der klinischen Praxis oft Forschungsergebnisse nur eine untergeordnete Rolle für das Fällen von Therapieentscheidungen oder die Auswahl von Behandlungsstrategien. Stattdessen vertrauen Therapeuten häufig auf das eigene klinische Urteil, was beispielsweise zu einer Unterschätzung der Wahrscheinlichkeit von Therapiemisserfolgen führen kann. Flexible Behandlungskonzepte werden in der Praxis häufig standardisierten Interventionen bevorzugt, beispielsweise in der Annahme, letztere würden von Patienten nicht akzeptiert. Jedoch gibt es neben überzeugenden Wirksamkeitsnachweisen auch aktuelle Daten, die eine hohe Wertschätzung standardisierter Interventionen wie strukturierte Interviews durch Patienten belegen. Neue Studien zeigen, dass eine wissenschaftlich orientierte Ausbildung sowohl die Akzeptanz evidenzbasierter Behandlungsmöglichkeiten durch Therapeuten als auch den Therapieerfolg erhöhen können. Um eine breitere Dissemination von Ergebnissen aus der Forschung zu erreichen sowie evidenzbasierte Behandlung zu fördern, sollten Psychotherapieforscher ihre Ergebnisse Praktikern leichter zugänglich machen und angehende Psychotherapeuten müssen eine wissenschaftlich fundierte Ausbildung erhalten.

BUILDING A RESEARCH-COMMUNITY COLLABORATIVE TO IMPROVE COMMUNITY CARE FOR INFANTS AND TODDLERS AT-RISK FOR AUTISM SPECTRUM DISORDERS

This article describes the formation and initial outcomes of a research-community collaborative group that was developed based on community-based participatory research principles. The group includes a transdisciplinary team of practitioners, funding agency representatives, researchers, and families of children with autism spectrum disorders, who partnered to improve community-based care for infants and toddlers at risk for autism through the implementation of evidence-based practices. Data from this group provide support for the feasibility of developing and sustaining a highly synergistic and productive research-community collaborative group who shares common goals to improve community care.

Theoretical and practical barriers to practitioners' willingness to seek training in empirically supported treatments

To identify barriers to the dissemination of empirically supported treatments (ESTs), a random sample of psychologists in independent practice (N=1291) was asked to complete measures of attitudes towards ESTs and willingness to attend a 3-hour, 1-day, or 3-day workshop in an EST of their choice. The strongest predictor of unwillingness to obtain EST training was the amount of time and cost required for the workshop, followed by objections to the need for EST training. Psychodynamic (compared to cognitive-behavioral) and more experienced practitioners agreed more strongly with the objections to ESTs overall, as did those whose graduate schools had not emphasized psychotherapy research. Results suggest that both practical and theoretical barriers are significant obstacles to EST dissemination.

Recent advances in behavioral addiction treatments: focusing on mechanisms of change

In the latter half of the 20th century, research on behavioral treatments for addictions aimed to develop and test effective treatments. Among the treatments found to be at least moderately effective, direct comparisons failed to reveal consistent superiority of one approach over another. This ubiquitous finding held true despite underlying theories that differed markedly in their proposed causal processes related to patient change. In the 21st century, the focus of treatment research is increasingly on how treatment works for whom rather than whether it works. Studies of active treatment ingredients and mechanisms of behavioral change, while promising, have yielded inconsistent results. Simple mediation analysis may need to be expanded via inclusion of models testing for moderated mediation, mediated moderation, and conditional indirect effects. Examples are offered as to how these more complex models can lead to increased understanding of the conditions under which specific treatment interventions will be effective and mechanisms of change operative in improving behavioral treatments for addictions.

Psychotherapy, psychopathology, research and practice: pathways of connections and integration

This paper describes three pathways of connections between different communities of knowledge seekers: integration of psychotherapeutic approaches, integration of psychotherapy and psychopathology, and integration of science and practice. Some of the issues discussed involve the delineation and investigation of common factors (e.g., principles of change), improvement of major forms of psychotherapy, clinical implications of psychopathology research, as well as current and future directions related to practice-research networks. The aim of this paper is to suggest that building bridges across theoretical orientations, scientific fields, professional experiences, and epistemological views may be a fruitful strategy to improve our understanding and the impact of psychotherapy.

Interesting practitioners in training in empirically supported treatments: research reviews versus case studies

It has been repeatedly demonstrated that clinicians rely more on clinical judgment than on research findings. We hypothesized that psychologists in practice might be more open to adopting empirically supported treatments (ESTs) if outcome results were presented with a case study. Psychologists in private practice (N=742) were randomly assigned to receive a research review of data from randomized controlled trials of cognitive-behavioral treatment (CBT) and medication for bulimia, a case study of CBT for a fictional patient with bulimia, or both. Results indicated that the inclusion of case examples renders ESTs more compelling and interests clinicians in gaining training. Despite these participants' training in statistics, the inclusion of the statistical information had no influence on attitudes or training willingness beyond that of the anecdotal case information.

Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges

One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.

Predictors of practitioner self-reported use of evidence-based practices: practitioner training, clinical setting, and attitudes toward research

In light of the recent movement toward evidence-based practice (EBP) in mental health services, practitioner adoption of EBPs in clinical settings has emerged as an important area for study. This paper reports on the results of a national online survey of mental health practitioners in an attempt to identify correlates of self-reported EBP use in practice. The survey consisted of 214 mental health practitioners from 15 states drawn from a diverse set of clinical settings and representing a variety of theoretical orientations. The results indicated that practitioner training (i.e., taking a class in EBPs), the perceived openness of the clinical setting toward EBPs, and the practitioner's attitudes toward treatment research were significant predictors of self-reported EBP use. The relationship between clinical setting and EBP use was partially mediated by attitudes toward treatment research. Negative attitudes toward treatment research partially mediated the relationship between practitioner training and self-reported EBP use. The findings are presented within the context of efforts to increase EBP use in clinical settings and implications for clinical training, treatment research, and EBP dissemination efforts are discussed.

Influences on practitioner treatment selection: best research evidence and other considerations

The recent movement toward evidence-based practice in mental health services has highlighted the importance of research evidence in treatment decisions. However, the fact that many treatments with strong research support are not widely used in clinical settings suggests that practitioners' decisions are not based on research alone but rather are influenced by other considerations. This study examines the relative importance of various considerations on practitioner treatment selection using a national survey of mental health practitioners including doctoral-level psychologists, master's-level psychologists, and master's-level clinical social workers (N = 206). Results indicate that practitioners are influenced by a range of considerations including empirical evidence from applied field studies, the perceived flexibility of a treatment, and the appeal of a treatment to colleagues and clients. These findings are discussed within the context of efforts to design, evaluate, and disseminate treatments with research support into clinical settings.