Hope in Cognitive Psychotherapies: On Working With Client Strengths

Predicting anxiety and depression over 12 months of the COVID-19 pandemic: A machine learning study

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic was associated with substantial increases in anxiety and depressive symptoms. To understand individual risk, we examined a large set of potential risk factors for anxiety and depression in the pandemic context.

METHODS

Adults in the United States (N = 1200) completed eight online self-report assessments over 12 months of the COVID-19 pandemic. Area under the curve scores summarized cumulative experiences of anxiety and depression over the assessment period. A machine learning approach to elastic net regularized regression was used to select predictors of cumulative anxiety and depression severity from a set of 68 sociodemographic, psychological, and pandemic-related baseline variables.

RESULTS

Cumulative anxiety severity was most strongly explained by stress and depression-related variables (such as perceived stress) and select sociodemographic characteristics. Cumulative depression severity was predicted by psychological variables, including generalized anxiety and depressive symptom reactivity. Being immunocompromised or having a medical condition were also important.

CONCLUSIONS

By considering many predictors, findings provide a more complete view than previous studies focused on specific predictors. Important predictors included psychological variables suggested by prior research and variables more specific to the pandemic context. We discuss how such findings can be used in understanding risk and planning interventions.

Injury, illness, and emotion: A review of the motivational continuum from trauma through recovery from an ecological perspective

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Anxiety, Stress Coping Styles and Hope for Success among Graduate Students and High School Graduates during the COVID-19 Pandemic: The Moderating Role of Remote Learning

The COVID-19 pandemic has significantly influenced the area of education, in terms of both teaching and learning effectiveness. The aim of the study was to compare groups of high school graduates and graduate students. The Coping Inventory in Stressful Situations (CISS), State and Trait Anxiety Inventory (STAI), Hope for Success Questionnaire (KNS), and our own questionnaire were used in the study. The results of the research show that the group of high school graduates, compared to the graduate students, was characterized by a higher level of anxiety, a style focused on emotions and a lower level of hope for success. People who passed the exam in the online form were characterized by a higher level of anxiety compared to the respondents who passed the exam in the stationary form. According to the results of this study, it can be concluded that the styles of coping and the level of hope for success may be both protective and risk factors related to the level of anxiety during distance learning.

The Unique Role of Hope and Optimism in the Relationship between Environmental Quality and Life Satisfaction during COVID-19 Pandemic

COVID-19 in Malaysia has significantly affected the higher education system of the country and increased the level of distress among university students. Empirical evidence proposed that environment quality is associated with university students’ life satisfaction during COVID-19. It was found that hope and optimism are linked with greater life satisfaction in general. Although past literature has reported the effects of hope and optimism on life satisfaction, there are limited studies examining the underlying mechanism among Malaysian private university students. Therefore, the current study offers the preliminary understanding of the intervening role of hope and optimism on the relationship between environmental quality and life satisfaction among private university students in Malaysia. A total of 133 private university students in Malaysia were recruited through homogenous convenience sampling. Partial least square structure equation modeling (SmartPLS) was used to analyze the mediation models. The results revealed that only hope mediated the relationship between environmental quality and life satisfaction, but not optimism. Hence, it is proposed that mental health providers should focus on providing hope-related interventions to university students in confronting COVID-19 challenges and ultimately improving life satisfaction.

Effectiveness of a brief hope intervention for chronic kidney disease patients on the decisional conflict and quality of life: a pilot randomized controlled trial

Background

Stage 5 chronic kidney disease (CKD) patients often experience decisional conflict when faced with the selection between the initiation of dialysis and conservative care. The study examined the effects of a brief hope intervention (BHI) on the levels of hope, decisional conflict and the quality of life for stage 5 CKD patients.

Methods

This is a single-blinded, randomized controlled trial (ClinicalTrials.gov identifier: NCT03378700). Eligible patients were recruited from the outpatient department renal clinic of a regional hospital. They were randomly assigned to either the intervention or the control group (intervention: n = 35; control: n = 37). All participants underwent a customized pre-dialysis education class, while the intervention group received also BHI. Data were collected prior to the intervention, immediately afterwards, and one month following the intervention. The Generalized Estimating Equation was used to measure the effects in the level of hope, decisional conflict scores (DCS) and Kidney Disease Quality of life (KDQOL-36) scores. Estimated marginal means and standard errors with 95% confidence intervals of these scores were also reported to examine the within group and between group changes.

Results

An increase of the hope score was found from time 1 (29.7, 1.64) to time 3 (34.4, 1.27) in the intervention group. The intervention had a significant effect on the KDQOL-36 sub-scores Mental Component Summary (MCS) (Wald χ² = 6.763, P = 0.009) and effects of kidney disease (Wald χ² = 3.617, P = 0.004). There was a reduction in decisional conflict in both arms on the DCS total score (Wald χ² = 7.885, P = 0.005), but the reduction was significantly greater in the control group (effect size 0.64).

Conclusions

The BHI appeared to increase the level of hope within the intervention arm. Nonetheless, differences across the intervention and control arms were not significant. The KDQOL-36 sub-scores on MCS and Effects of kidney disease were found to have increased and be higher in the intervention group. The DCS total score also showed that hope was associated with reducing decisional conflict.

Trial Registration

ClinicalTrials.gov Protocol Registration, NCT03378700. Registered July 12 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02830-7.

Worry and Positive Episodes in the Daily Lives of Individuals With Generalized Anxiety Disorder: An Ecological Momentary Assessment Study

Worry is a central feature of generalized anxiety disorder (GAD). Although worry is related to anxiety and maintained by beliefs that worry is uncontrollable, there is scarce research on how individuals with GAD react to worry episodes in their daily life and how their positive experiences might impact reactions to worry episodes. The current study examined the level and variability of anxiety and controllability during high worry periods and positive experiences in GAD. Moreover, it investigated the influence of worry and positive experiences on later anxiety and perceived controllability within-persons. Finally, it examined change in anxiety level from previous to current episodes depending on previous episodes type. In the current study, 49 individuals with GAD (514 observations) registered their worry and positive episodes (i.e., episodes in which they had positive experiences) and reported on several variables during these episodes (i.e., anxiety and controllability of episodes and episode duration) using smartphone-based ecological momentary assessment for 7days. Results show anxiety and controllability differed by episode type (higher anxiety, lower controllability in worry episodes, and the opposite in positive episodes), and notable within-person variability in anxiety and controllability in both episode types. The time-lagged multilevel models showed episode type did not predict later anxiety during either episode type, although previous anxiety predicted current anxiety in worry episodes (but not positive episodes). Moreover, worry episodes did predict later controllability in worry episodes (but not positive episodes) and previous controllability predicted current controllability in both episode types. Furthermore, we obtained the increase in anxiety from t₀₋₁ to t₀ in a current worry episode to be significantly smaller when preceded by a worry (vs. positive) episode. Likewise, the reduction in anxiety from t₀₋₁ to t₀ in a current positive episode was significantly larger when preceded by a worry (vs. positive) episode. The novel findings in the current study that perceptions of controllability and anxiety vary within individuals with GAD, that greater controllability is experienced in positive episodes than worry episodes, and that worry may confer a sense of controllability at a later time could be seen as important contributions to the GAD literature.

Risk and protective factors among at-risk ultraorthodox Jewish youth in Israel: A contextual model of positive adjustment

This study examined the role of personal (mastery), familial (relationship with parents), and communal (sense of community and sense of belonging to a youth centre) aspects for at-risk youths' adjustment. Specifically, we investigated their role as protective and risk factors for behavioural adjustment (risk behaviour) and psychological adjustment (hope). The study, conducted among Ultraorthodox Jewish males, included 80 participants, ages 14-24 (M = 16.8, SD = 2.33), who attended youth centres designed especially for Ultraorthodox at-risk youth, in five cities with a high percentage of Ultraorthodox population. Findings indicated a significant contribution of mastery to lower levels of risk behaviour and to higher levels of hope. The youth/parent relationship made a significant contribution only to lower levels of risk behaviours, while sense of community made a significant positive contribution only to hope. Surprisingly, the sense of belonging to a youth centre was found to be a risk factor for higher levels of risk behaviours. In contrast, a mediation model revealed an indirect positive contribution of sense of belonging to a youth centre to hope via mastery. The discussion highlights the unique phenomena of at-risk youth in the Ultraorthodox community and suggest carefully and thoroughly checking whether youth centres in this context should actually be discouraged. It also addresses the importance of recognising the unique protective and risk factors for positive adjustment among at-risk Ultraorthodox youth.

Early Pandemic Experiences of Autistic Adults: Predictors of Psychological Distress

The COVID‐19 pandemic has disrupted lives around the world. Autistic adults are at higher risk for co‐occurring medical and psychiatric conditions and may be more prone to difficulties adapting to pandemic‐related changes and social distancing mandates and coping with ongoing uncertainties. On the other hand, the pandemic may lead to greater understanding and acceptance of accommodations in the broader community that may facilitate supports for autistic adults beyond the pandemic. To learn more about their early pandemic experiences, online surveys were sent to independent adults enrolled in the Simons Powering Autism Research Knowledge (SPARK). The first survey was open from March 30 to April 19, 2020; a follow‐up survey sent to original responders was open from May 27 to June 6, yielding 396 participants with data for both surveys. We found that adults who were female, younger, had prior diagnoses of a mental health condition, personal COVID‐19 experience (i.e., knowing someone who had symptoms or tested positive) or less frequent hope for the future reported the greatest negative impacts. Decrease in feelings of hopefulness over time predicted greater psychological distress at T2, accounting for T1 impact and distress levels and increases in total COVID‐19 impact. Less perceived benefit of online services also predicted later distress. Although there tends to be a focus on coping with negative effects of the pandemic, mental health providers may consider approaches that focus on positives, such as fostering hope and understanding factors that facilitate benefit from online services.

The Role of Hope to Alleviate Anxiety in COVID-19 Outbreak among Community Dwellers: An Online Cross-sectional Survey

Introduction: The worldwide emergence of COVID-19 has been associated with diverse consequences, including anxiety. Hope is believed to act as a motivation to enable one to cope with the anxiety. This study was conducted to identify the role of hope in alleviating anxiety due to the COVID-19 outbreak during the primary phase among community dwellers in Iran. Methods: This cross-sectional study recruited 3,565 subjects with the convenience sampling method. Data collection tools used included the COVID-19 knowledge checklist, Generalised Anxiety Disorder (GAD-7) questionnaires and Snyder Hope Scale. Participants were asked to fill in the questionnaires online. The data were analysed using descriptive and inferential statistics (multivariate linear regression analysis). Results: Participants’ mean scores of anxiety and hope were 6.06±4.52 and 31.27±4.52, respectively. The results indicated that 27.1% of the changes in the anxiety scores were predictable with some of the variables examined in this study. A high score of hope was directly associated with a lower level of anxiety. In addition, the number of hours spent following news and information on COVID-19 was significantly related to anxiety level. Moreover, female gender, urban residence, and having relatives suffering from COVID-19 were significantly related to a higher level of anxiety (P<0.05). Conclusion: The morbidity and mortality associated with the COVID-19 outbreak had brought a lot of anxiety among community dwellers. Hope, potentially, can contribute to overcoming anxiety. Therefore, health policymakers can introduce appropriate social interventions to enable the community to cope with stress and anxiety. Keywords: Generalised anxiety disorder, hope, mental health, pandemic

The effects of a brief hope intervention on decision-making in chronic kidney disease patients: A study protocol for a randomized controlled trial

AIMS

This study describes the study protocol of a manualized brief hope intervention that is based on the theoretical proposition - hope theory.

BACKGROUND

Patients with stage 5 chronic kidney disease often had decisional regret when facing the tension of treatment alternatives between dialysis initiation and palliative care. Hope has been found to account for therapeutic changes in clients with depressive symptoms, heightens positive expectations, and striving to accomplish chosen goals. Nevertheless, little is known about the effect of hope on decisional conflict and its influences to the quality of life in these chronic kidney disease patients.

DESIGN

This study is a single-blinded, randomized controlled trial.

METHODS

Participants will be recruited from a regional hospital (approved in April 2018). They will be randomly assigned in equal numbers to either the brief hope intervention or the control arm on completion of the baseline assessment on the possible need of dialysis initiation. Participants in the intervention group will receive the pre-dialysis education and a 4-week Brief Hope Intervention [consisting of four sessions at weekly intervals (two face-to-face sessions and two telephone follow-up sessions in between)], while those allocated to the control arm will receive the renal education and social chats. Outcome measures will be carried out prior to the intervention (baseline), immediately, and 1 month after the intervention. These consist of the hope level, decisional conflict, and quality of life. Healthcare resources use data will be reported.

IMPACT

The study results have the potential to add scientific evidence to the research-tested programme when developing renal services integral to multimodal care management to optimize decision-making and attain better health outcomes.

Examining Hope as a Transdiagnostic Mechanism of Change Across Anxiety Disorders and CBT Treatment Protocols

Hope is a trait that represents the capacity to identify strategies or pathways to achieve goals and the motivation or agency to effectively pursue those pathways. Hope has been demonstrated to be a robust source of resilience to anxiety and stress and there is limited evidence that, as has been suggested for decades, hope may function as a core process or transdiagnostic mechanism of change in psychotherapy. The current study examined the role of hope in predicting recovery in a clinical trial in which 223 individuals with 1 of 4 anxiety disorders were randomized to transdiagnostic cognitive behavior therapy (CBT), disorder-specific CBT, or a waitlist controlled condition. Effect size results indicated moderate to large intraindividual increases in hope, that changes in hope were consistent across the five CBT treatment protocols, that changes in hope were significantly greater in CBT relative to waitlist, and that changes in hope began early in treatment. Results of growth curve analyses indicated that CBT was a robust predictor of trajectories of change in hope compared to waitlist, and that changes in hope predicted changes in both self-reported and clinician-rated anxiety. Finally, a statistically significant indirect effect was found indicating that the effects of treatment on changes in anxiety were mediated by treatment effects on hope. Together, these results suggest that hope may be a promising transdiagnostic mechanism of change that is relevant across anxiety disorders and treatment protocols.

A Brief Hope Intervention to Increase Hope Level and Improve Well-Being in Rehabilitating Cancer Patients: A Feasibility Test

This article reports on the feasibility and effect of the brief hope intervention (BHI) in terms of increasing the hope level and psychological and physical health outcomes of rehabilitating cancer patients (RCP). Chinese RCP living in the community were invited to join the study. The BHI consisted of four one-on-one sessions: two (1-hour) face-to-face sessions and two (30-minute) telephone follow-up sessions in between. There were three core features in the hope therapy: (a) goal thoughts: finding workable goals, (b) pathway thoughts: finding ways to reach the targets, and (c) agency thoughts: positive self-talk to optimize their motivation to accomplish the set goals. A one-group pre- and postintervention design was used. Outcome measures included the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression Scale (CES-D), and the State Hope Scale. Recruitment, attrition, and qualitative feedback were collected to understand their comments on BHI. A total of 40 participants were recruited (female 92.3%). The mean age was 57.2 years (SD = 6.7). The participants had significant improvement in all aspects of the Memorial Symptom Assessment Scale, with moderate-to-large effect sizes (d = 0.49-0.74). The changes in present hope and depression scores were insignificant, with small effect sizes (d = 0.17-0.34). The BHI seemed to be promising in producing both physical and psychological benefits in RCP.

A Gender-Responsive Treatment Facility in Correctional Services: The Development of Psychological Gymnasium for Women Offenders

With increasing evidence suggesting a disparity in female and male offenders in terms of rehabilitative needs, growing concern has been placed on the development of gender-specific services for female offenders. As such, a prison-based psychological gymnasium (PSY GYM), with distinctive features in integrating cognitive-behavioral and positive-psychology concepts to address female offenders' needs, was set up in 2011. The present study aims to introduce the concept as well as present findings to evaluate the overall effectiveness of PSY GYM. Nineteen Chinese female offenders participated in a 6- to 8-month intensive training program at the Lo Wu Correctional Institution (LWCI) of the Hong Kong Correctional Services Department in Hong Kong. Psychometric inventories were used to assess their psychological distress and positive growth following the program. Participants showed significant reduction in their depression, anxiety, and stress symptoms, and in their tendency to pay attention to negative information. Furthermore, their sense of hope, gratitude, and tendency to pay attention to positive information had remarkably increased. This indicated the effectiveness of PSY GYM in facilitating successful rehabilitation for female offenders.

Effectiveness of Hope Therapy Protocol on Depression and Hope in Amphetamine Users

Background:

Addiction has surpassed the boundaries of health and treatment and turned into a social crisis and a debilitating and major concern in today’s world. Amphetamine, one of the addictive drugs, is classified as psycho-stimulants drugs, which increase arousal, alertness, and motor activity. Humans report that this drug produces a significant euphoria and is highly addictive.

Objectives:

The present study aimed to evaluate the effectiveness of hope therapy protocol (HTP) on depression reduction and hope increase in amphetamine users.

Patients and Methods:

This study has a quasi-experimental design with experimental and control groups. The sample included all amphetamine consumers referring to day drug addiction treatment center in Ray City, Iran, selected with convenience method. In order to analyze the data, multivariate analysis of covariance (MANCOVA) was applied using SPSS software.

Results:

The results showed that F value of mean scores in depression and hope post-tests of the experimental and control groups are 24.94 and 25.73, respectively, which are significant (P < 0.01). Therefore, hope therapy training could reduce depressive symptoms in amphetamine consumers and improve their hope.

Conclusions:

Performing HTP can improve hopefulness and symptoms of patients, specially addicted ones. In addition, it can prevent substance abusers from returning to drugs and leaving the treatment period unfinished.

Development and Validation of the Hope for Change Through Counseling Scale

Frank and Frank suggested that the primary goal of contextually oriented therapy is remoralization through the promotion of hope. According to Snyder’s hope theory, hope is a psychological characteristic consisting of pathways thinking, agency, and goals. Although these concepts are relevant to understanding how hope develops through therapy, no instrument exists to measure hope within counseling. The present research was undertaken to develop and validate the Hope for Change Through Counseling Scale (HCCS). Study 1 ( N = 191) was an analogue study to pilot the scale and identify its factor structure. Study 2 ( N = 306) consisted of a confirmatory factor analysis to further refine the HCCS. Study 3 utilized the HCCS with clients ( N = 50), providing evidence of construct validity and incremental validity for the scale. Implications of the HCCS as an assessment tool to facilitate focus on client hopefulness within counseling are discussed.

Spirituality, hope, and self-sufficiency among low-income job seekers

Self-sufficiency (SS) is an important social welfare policy goal in the United States, yet little is known about the process that leads to SS. To address this gap in the literature, this study examined the relationship between spirituality, hope, and SS among a sample of low-income job seekers (N = 116). It was hypothesized that spirituality would be related to hope, and that hope, in turn, would be related to SS. Using survey data from two workforce development agencies, this hypothesis was confirmed-hope fully mediated the relationship between spirituality and SS. Of the two factors through which hope is commonly operationalized-agency and pathways-supplemental analysis suggested that spirituality only affects SS through the agency channel. To help foster hope in direct practice settings, it is suggested that social workers might employ spiritually modified cognitive-behavioral therapy protocols. Macrostructural interventions that block the pathway component of hope are also suggested to help reverse exclusion from labor market entry. As such, hope needs to be addressed comprehensively-intrapsychically and macrostructurally-to effect bottom-up change for SS. Engendering hope may assist clients overcome some of the many challenges they encounter on the journey to SS.

Acute symptoms of posttraumatic stress and dissociative experiences among female israeli civilians exposed to war: the roles of intrapersonal and interpersonal sources of resilience

BACKGROUND

The positive personality characteristics of optimism, hope, self-esteem, and perceived availability of social support are believed to play an important role in psychological adjustment to stressful life events. For example, these characteristics have been shown to be associated with fewer mood disturbances in response to a variety of stressors. However, relatively little is known about the extent to which these characteristics serve as sources of resilience among civilians during real-time exposure to war.

OBJECTIVE

This "natural laboratory" study examined the role that individual differences both in intrapersonal (i.e., positive personality features of hope, optimism, and self-esteem) and in interpersonal (i.e., perceived social support from family, friends, and significant others) sources of resilience may play in the development of acute anxiety symptoms of posttraumatic stress disorder (PTSD) and dissociative experiences during exposure to war.

METHOD

A nonclinical community sample of 140 female adults was assessed during real-time exposure to missile and rocket fire during an eruption of violence in the Middle East in November 2012.

RESULTS

The results demonstrate that both intrapersonal and interpersonal sources of resilience were negatively associated with acute PTSD and dissociative symptoms.

CONCLUSION

The findings of this study provide evidence that both intrapersonal and interpersonal sources of resilience may significantly mitigate the risk for acute anxiety symptoms among civilian communities exposed to traumatic events.

Socioemotional self-perceptions, family climate, and hopeful thinking among students with learning disabilities and typically achieving students from the same classes

This study aimed at examining the adjustment of students with learning disabilities (LD) and at exploring the mediating role of hope. By means of a multidimensional approach, the interactions between risk and protective factors emerging from internal and external resources among 856 high school students (10th to 12th grades) were analyzed. A total of 529 typically achieving students and 327 students with LD attending general education classes in seven high schools completed seven instruments measuring sense of coherence, basic psychological needs, loneliness, family climate, hope, academic self-efficacy, and effort. The students' achievements in English, history, and mathematics were collected. The analysis used structural equation modeling, and the results emphasized the significant role of hope as a mediator between risk and protective factors and academic self-efficacy and its significance for students with and without LD in explaining achievements and effort investment.

Students with LD in higher education: use and contribution of assistive technology and website courses and their correlation to students' hope and well-being

This study examined the extent and patterns of usage of web courses, and their contribution to the academic and social perceptions of 964 undergraduate students with and without learning disabilities studying in higher education. Students were asked to complete four questionnaires examining the usage patterns of various adaptive technologies and their contribution to the student. The questionnaires assessed Perceptions of Learning through Online Usage; Accessibility of Campus Computing; Hope Scale and Subjective Well-being Scale. A detailed examination of the usage patterns of online courses revealed that, compared to the comparison group, students with LD log more often into the course sites, going into the forum more frequently and leaving significantly more messages on the forum than students in the comparison group. Findings indicated that students with LD are more familiar with assistive technology and use it more than the comparison group. Students with LD reported higher scores on the Hope scale, they felt an increased drive to find different pathways to attain their goals, as well as being motivated to pursue those goals, and their subjective well-being was higher that of the students in the comparison group.

Enhancing Lives: A Positive Psychology Agenda for Hypnotherapy

Hypnotherapy is established as treatment modality for psychological distress, but it is also well-suited to facilitate well-being. Some hypnotherapeutic approaches value and utilize unconscious resources, and can therefore be aligned with positive psychology's focus on identifying, enhancing and utilizing psychological strengths. However, literature on integrating positive psychology principles in hypnotherapeutic practice is limited. The aim of this article is to elucidate the synergy between hypnotherapy and positive psychology by reviewing existing practices and research findings. Suggestions for integrating knowledge from positive psychology into hypnotherapeutic strategies are also offered, particularly as it relates to interventions aimed at enhancing psychological strengths and positive emotions. Finally, recommendations for research are proposed. To advance the theory and practice of hypnotherapy in the 21st century it is imperative to investigate the effectiveness of hypnotherapeutic strategies, informed by positive psychology, in the South African context. Research methodologies that offer insight into the unfolding of individual therapeutic change, as well as the subjective experience of clients and therapists, are particularly encouraged.

Children's loneliness, sense of coherence, family climate, and hope: developmental risk and protective factors

The study examined the contributions of individual and familial variables for the prediction of loneliness as a developmental risk and the sense of coherence as a protective factor. The sample consisted of 287 children from grades 5-6. Their loneliness, sense of coherence, hope, effort, and family climate were assessed. Separate hierarchical multiple regression analyses revealed that family cohesion and children's hope contributed to the explanation of the risk and protective outcomes. Yet, the contribution of the family adaptability was not significant. Cluster analysis of the family climate dimensions (i.e., cohesion and adaptability) was performed to clarify the interactive roles of family adaptability together with family cohesion. The authors identified 4 separate family profiles: Children in the 2 cohesive families' clusters (Cohesive Structured Families and Cohesive Adaptable Families) reported the lowest levels of loneliness and the highest levels of personal strengths. Children within rigid and noncohesive family cluster reported the highest levels of loneliness and the lowest levels of children's sense of coherence. The unique role of the family flexibility within nonsupportive family systems was demonstrated. The results further clarified the unique profiles' characteristics of the different family clusters and their adjustment indexes in terms of loneliness and personal strengths.

The relationship between therapist and client hope with therapy outcomes

The current study examined whether clients' perceptions of hope and therapists' hope in their clients were associated with therapy outcomes. The authors conducted a naturalistic study of brief therapy with 10 therapists and 43 adult clients. Client-rated hope significantly increased after one session of therapy. However, no significant relationship was found between pretherapy client-rated hope and first-session symptom change. Further, client-rated hope at any point in therapy was not significantly related to therapy outcomes. Therapists' hope in their clients after the first and last sessions was significantly related to client outcomes. Implications for therapy practice and research are offered.

The future and promise of cognitive behavioral therapy: a commentary

The Academy for Psychological Clinical Science and the independent accrediting entity it created, the Psychological Clinical Science Accreditation system, have recently launched a movement aimed at reforming all of clinical psychology. If this movement is successful, it will result in a greater emphasis on empirical science in the practice of clinical psychology. As cognitive behavioral therapy (CBT) is the approach that currently has the greatest number of controlled scientific studies supporting it, this should be an impetus for CBT to grow. The very same scientific evidence that supports the efficacy of CBT, however, also shows that CBT is far from fully efficacious. Several recent trends that hold great promise to enhance the effectiveness of CBT are discussed, such as greater integration of CBT with biological approaches, cognitive science, systemic approaches, motivational interviewing, and strengths-based approaches.

Ambulant children with spastic cerebral palsy and their parents' perceptions and expectations prior to multilevel surgery

PURPOSE

This study explores the pre-operative situation of children accepted for multilevel surgery for cerebral palsy (CP) and their parents.

METHODS

Eight ambulatory children with varied severity of spastic CP and their parents were included. Qualitative, semi-structured interviews were carried out separately with the children and parents.

RESULTS

Everyday life of the children and their parents was vulnerable. The degree to which children strived for social acceptance and normality increased their pain. Deteriorating physical capacity resulted in pain and fatigue and was the parents' and children's main motivation for the operation. Although the parents were ambivalent to the operation they mediated hope and cautious optimism about a better life for their children.

CONCLUSION

Parents' and children's experiences imply the need for improvements to ensure facilitation for disabled children in schools and all levels of the health service, equality of communication and awareness-raising in the pre-operative phase of multilevel surgery.