Supervisor versus self-assessment of trainee competence: Differences across developmental stages and competency domains

OBJECTIVES

This research aimed to systematically examine supervisor-trainee differences in assessments of trainee competencies across domains and developmental stages.

METHODS

Trainees and supervisors (N = 141 dyads) independently rated trainee performance at the end of placements using the Clinical Psychology Competencies Rating Scale. Based on the number of placement hours completed at the time competence was assessed, the 141 trainees were assigned to three developmental levels (61, 42, and 31 in the groups, respectively). Trajectories of 10 different competencies and trainee-supervisor differences for these competencies were examined across three developmental levels.

RESULTS

Compared to their supervisor ratings, trainees underestimated their competence during early stages of training, with this discrepancy reducing at Level 2 and reversing into an overestimation at Level 3. Compared to their own ratings for overall competence, trainees rated Relational and Communication, Reflective Practice, and Professionalism domains as relative strengths, and rated their competence on assessment and intervention domains as relative weaknesses.

CONCLUSION

Growth trajectories derived from supervisor assessments were much flatter than trajectories derived from trainee assessments. As predicted by the impostor theory of practitioner development, trainees significantly underestimated their competence early in training. The trend for trainees to overestimate their competence toward the end of their training is a potential concern that warrants further research.

Barriers to the use of exposure therapy by psychologists treating anxiety, obsessive-compuslive disorder, and posttraumatic stress disorder in an Australian sample

BACGROUND

Exposure therapy is a core component of the evidence-based treatment of anxiety, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Despite this, many clinicians fail to use exposure therapy in clinical practice, with research highlighting a number of potential barriers. Those findings raise serious concerns regarding the effective dissemination and delivery of evidence-based treatments that in turn have a major impact on client care and cost-effectiveness of psychological interventions.

AIMS

The present study aims to examine barriers to the use of exposure therapy in the clinical practice of Australian psychologists treating anxiety, OCD and PTSD.

METHOD

One hundred registered psychologists, aged between 23 and 71 years and 84% female, participated in this study via online survey.

RESULTS

Results suggest that the most common barriers to the use of exposure therapy include lack of confidence, negative beliefs about exposure therapy, insufficient underpinning theoretical knowledge, client-specific barriers, and logistical limitations.

CONCLUSIONS

Future research may further examine those barriers and the components of additional training and supervision that can increase the uptake of exposure therapy, particularly in clinical areas where it is a gold standard of practice.

A short scale to evaluate supervision and supervisor competence-The SE-SC8

There is an urgent need for instruments to evaluate supervisor competence. The current study describes the development of the SE-SC8, an eight-item version of a previously published Supervision Evaluation and Supervisory Competence scale that has adequate reliability and validity. The current study analysed data from the sample (N = 142) used in the initial validation of the full scale to identify the best set of items for a short scale before testing the scale's psychometric properties in a new study (N = 122). The SE-SC8 demonstrated good reliability and adequate convergent and divergent validity. The SE-SC8 has two overall items respectively measuring supervisor effectiveness and supervision satisfaction and six items that represent supervisory competencies, namely, (1) Openness, Caring and Support, (2) Supervisor's Knowledge and Expertise as Therapist, (3) Supervision Planning and Management, (4) Goal-Directed Supervision, (5) Restorative Competencies, and (6) Insight into and Management of Therapist-Client Dynamics and Reflective Practitioner Competencies. As with other subjective ratings, SE-SC8 scores should be supplemented by other assessments for a holistic appraisal of supervisor competence.

The age-related positivity effect in electronic gambling

BACKGROUND

Older adults are increasingly spending time and money playing electronic gambling machines (EGMs). The current study assessed whether the age-related positivity effect influences responding to various EGM outcomes, including wins and losses of equivalent magnitude and frequency. We also explored cognitive mechanisms potentially underpinning the positivity effect.

METHODS

We recorded the skin conductance response (SCR) of healthy older and younger adults while they played for wins, losses, and fake wins (losses disguised as wins). After every win and fake win, participants were forced to choose red or black to either double their win or lose it. They also provided ratings of enjoyment and excitement, estimated number of wins and losses, and completed measures of cognitive function.

RESULTS

Young and older adults demonstrated larger SCRs to wins relative to losses. When these wins and losses were of equivalent magnitude and frequency following a double-or-nothing scenario, only older adults responded more to a win than a loss. There were no age group differences in excitement and enjoyment, but older adults were more accurate than young adults in their recall of wins and losses.

CONCLUSION

During EGM play, young and older adults demonstrate similar patterns on autonomic arousal. However, young adults' responding suggests generalized excitement, whereas older adults respond more to the prospect of financial gain.

Sequential Processing and the Matching-Stimulus Interval Effect in ERP Components: An Exploration of the Mechanism Using Multiple Regression

In oddball tasks, increasing the time between stimuli within a particular condition (target-to-target interval, TTI; nontarget-to-nontarget interval, NNI) systematically enhances N1, P2, and P300 event-related potential (ERP) component amplitudes. This study examined the mechanism underpinning these effects in ERP components recorded from 28 adults who completed a conventional three-tone oddball task. Bivariate correlations, partial correlations and multiple regression explored component changes due to preceding ERP component amplitudes and intervals found within the stimulus series, rather than constraining the task with experimentally constructed intervals, which has been adequately explored in prior studies. Multiple regression showed that for targets, N1 and TTI predicted N2, TTI predicted P3a and P3b, and Processing Negativity (PN), P3b, and TTI predicted reaction time. For rare nontargets, P1 predicted N1, NNI predicted N2, and N1 predicted Slow Wave (SW). Findings show that the mechanism is operating on separate stages of stimulus-processing, suggestive of either increased activation within a number of stimulus-specific pathways, or very long component generator recovery cycles. These results demonstrate the extent to which matching-stimulus intervals influence ERP component amplitudes and behavior in a three-tone oddball task, and should be taken into account when designing similar studies.

Electrophysiology of Memory-Updating Differs with Age

In oddball tasks, the P3 component of the event-related potential systematically varies with the time between target stimuli—the target-to-target interval (TTI). Longer TTIs result in larger P3 amplitudes and shorter latencies, and this pattern of results has been linked with working memory-updating processes. Given that working memory and the P3 have both been shown to diminish with age, the current study aimed to determine whether the linear relationship between P3 and TTI is compromised in healthy aging by comparing TTI effects on P3 amplitudes and latencies, and reaction time (RT), in young and older adults. Older adults were found to have an overall reduction in P3 amplitudes, longer latencies, an anterior shift in topography, a trend toward slower RTs, and a flatter linear relationship between P3 and TTI than young adults. Results suggest that the ability to maintain templates in working memory required for stimulus categorization decreases with age, and that as a result, neural compensatory mechanisms are employed.

Electrophysiology of facilitation priming in obsessive-compulsive and panic disorders

OBJECTIVE

Repeated experience with stimuli often primes faster, more efficient neuronal and behavioural responses. Exaggerated repetition priming effects have previously been reported in obsessive-compulsive disorder (OCD), however little is known of their underlying neurobiology or disorder-specificity, hence we investigated these factors.

METHODS

We examined event-related potentials (ERPs) and behaviour while participants with OCD, panic disorder and healthy controls (20 per group) performed a Go/NoGo task which manipulated target repetition sequences.

RESULTS

Both clinical groups showed stronger reaction time (RT) priming than HCs, which in OCD was greater in a checking, than washing, subgroup. Both clinical groups had similar RT deficits and ERP anomalies across several components, which correlated with psychopathology and RT priming. In OCD alone, N1 latency tended to increase to repeated stimuli, correlated with O-C symptoms, whereas it decreased in other groups. OCD-checkers had smaller target P2 amplitude than all other groups.

CONCLUSIONS

Enhanced neural priming is not unique to OCD and may contribute to salient sensory-cognitive experiences in anxiety generally. These effects are related to symptom severity and occur to neutral stimuli and in the context of overall RT impairment, suggesting they may be clinically relevant and pervasive. The results indicate overlapping information-processing and neurobiological factors across disorders, with indications of OCD-specific trends and subgroup differences.

SIGNIFICANCE

This first electrophysiological investigation of OCD priming in OCD to include anxious controls and OCD subgroups allows for differentiation between overlapping and OCD-specific phenomena, to advance neurobiological models of OCD.

Evaluation of psychology practitioner competence in clinical supervision

There is a growing consensus favouring the development, advancement, and implementation of a competency-based approach for psychology training and supervision. There is wide recognition that skills, attitude-values, and relationship competencies are as critical to a psychologist's competence as are knowledge capabilities, and that these key competencies are best measured during placements, leaving the clinical supervisor in an unparalleled position of advantage to provide formative and summative evaluations on the supervisee's progression towards competence. Paradoxically, a compelling body of literature from across disciplines indicates that supervisor ratings of broad domains of competence are systematically compromised by biases, including leniency error and halo effect. The current paper highlights key issues affecting summative competency evaluations by supervisors: what competencies should be evaluated, who should conduct the evaluation, how (tools) and when evaluations should be conducted, and process variables that affect evaluation. The article concludes by providing research recommendations to underpin and promote future progress and by offering practice recommendations to facilitate a more credible and meaningful evaluation of competence and competencies.

Can event-related potentials serve as neural markers for wins, losses, and near-wins in a gambling task? A principal components analysis

Originally, the feedback related negativity (FRN) event-related potential (ERP) component was considered to be a robust neural correlate of non-reward/punishment processing, with greater negative deflections observed following unfavourable outcomes. More recently, it has been suggested that this component is better conceptualised as a positive deflection following rewarding outcomes. The current study sought to elucidate the nature of the FRN, as well as another component associated with incentive-value processing, the P3b, through application of a spatiotemporal principal components analysis (PCA). Seventeen healthy controls played a computer electronic gaming machine (EGM) task and received feedback on credits won or lost on each trial, and ERPs were recorded. The distribution of reward/non-reward outcomes closely matched that of a real EGM, with frequent losses, and infrequent wins and near-wins. The PCA revealed that feedback elicited both a frontally maximal negative deflection to losses, and a positive deflection to wins (which was also sensitive to reward magnitude), implying that the neural generator/s of the FRN are differentially activated following these outcomes. As expected, greater P3b amplitudes were found for wins compared to losses. Interestingly, near-wins elicited significantly smaller FRN amplitudes than losses (with no differences in P3b amplitude), and may contribute to the maintenance of gambling behaviours on EGMs. The results of the current study are integrated into a response profile of healthy controls to outcomes of varying incentive value. This may provide a foundation for the future examination of individuals who exhibit abnormalities in reward/punishment processing, such as problem gamblers.

Comparing P300 modulations: target-to-target interval versus infrequent nontarget-to-nontarget interval in a three-stimulus task

This study examined temporal determinants of the P300 component of the ERP in a three-stimulus visual oddball task. Frequent standards, with equiprobable targets and infrequent nontargets, were utilized. We tested whether the infrequent nontarget-to-nontarget interval (infrequent NNI) influences P300 amplitudes and latencies analogously to the target-to-target interval (TTI). EEG was recorded from 27 participants, and response time and P300 effects of TTIs and infrequent NNIs were assessed. Increases in TTI augmented target P300 amplitudes and decreased latencies and response times. However, this modulation of P300 amplitude was weak for manipulations of infrequent NNI. P300 latencies increased initially before decreasing across infrequent NNI levels. Together, these findings support the notion that the P300 has an underlying temporal mechanism that is modulated by motivationally significant events. Theoretical implications are discussed.

Effects of supervision modality and intensity on alliance and outcomes for the supervisee

OBJECTIVE

Clinical supervision within the health professions is an important quality control mechanism to ensure good client care. The purpose of this study was to assess how supervision structure and process affect supervision outcomes for the supervisee.

DESIGN

A repeated measures within groups and between groups (individual or group supervision) design was used to explore the effects of a 6-month supervision program for staff of public sector drug and alcohol health services. Ten supervisors and 42 supervisees were allocated to either individual or group supervision conditions. Measures were completed at 3 points over a 9-month period, including a 3-month waitlist control period of no supervision.

RESULTS

Mean supervisee ratings indicated positive evaluations for supervision satisfaction and perceived effectiveness in individual and group conditions. Although an increase in burnout and decrease in wellbeing was observed during the period of supervision, these changes are hypothesized to be related to extraneous organizational issues. Enhanced perceived supervision effectiveness and positive supervisory alliance were associated with lower levels of burnout and higher levels of wellbeing and job satisfaction within the individual supervision condition. Supervisee ratings of alliance were strongly correlated with ratings of perceived supervision effectiveness in individual and group conditions.

CONCLUSIONS

These results suggest that supervision can have important positive impacts on the supervisee's functioning and wellbeing when that supervision involves a positive alliance.

Testing an empirically derived mental health training model featuring small groups, distributed practice and patient discussion

OBJECTIVES

Internationally, family doctors seeking to enhance their skills in evidence-based mental health treatment are attending brief training workshops, despite clear evidence in the literature that short-term, massed formats are not likely to improve skills in this complex area. Reviews of the educational literature suggest that an optimal model of training would incorporate distributed practice techniques; repeated practice over a lengthy time period, small-group interactive learning, mentoring relationships, skills-based training and an ongoing discussion of actual patients. This study investigates the potential role of group-based training incorporating multiple aspects of good pedagogy for training doctors in basic competencies in brief cognitive behaviour therapy (BCBT).

METHODS

Six groups of family doctors (n = 32) completed eight 2-hour sessions of BCBT group training over a 6-month period. A baseline control design was utilised with pre- and post-training measures of doctors' BCBT skills, knowledge and engagement in BCBT treatment.

RESULTS

Family doctors' knowledge, skills in and actual use of BCBT with patients improved significantly over the course of training compared with the control period.

CONCLUSIONS

This research demonstrates preliminary support for the efficacy of an empirically derived group training model for family doctors. Brief CBT group-based training could prove to be an effective and viable model for future doctor training.

Target-to-target interval, intensity, and P300 from an auditory single-stimulus task

Target-to-target interval (TTI) is a primary determinant of P300 amplitude, such that longer TTIs yield larger components than shorter intervals. Systematic manipulations of TTI affect component amplitude, latency, and associated response time in a fashion that suggests that the template update hypothesis can account for these outcomes. The present study examines whether manipulations of TTI (from 1 to 16 s) and stimulus intensity (soft and loud tones) produce outcomes consistent with this hypothesis. A single-stimulus task was employed in which only target stimuli were presented. P300 amplitude increased, peak latency decreased, and response time increased as TTI became longer, with less effect for soft compared to loud stimulus conditions on P300 amplitude at Pz. TTI increases also augmented N100 amplitude, with consistently smaller amplitudes obtained for soft relative to loud stimuli. Overall, P300 measures are sensitive to both temporal and physical stimulus factors. Theoretical implications are discussed.

Event-related potentials during an emotional Stroop task

Emotional Stroop tasks have gained wide interest in scientific literature in the last two decades. Although no direct measure of attention is employed, these studies infer the presence of preferential processing of threatening information based on reaction time (RT) impairment in a competing task. Because event-related potential (ERP) measures are sensitive to both the extent (amplitude) and speed (latency) of cerebral processing, they are valuable tools with which to examine more directly the claim that threatening stimuli are associated with enhanced attention. Twenty-two students rated a pool of words to identify those that were personally disturbing. Two word types (threat and neutral) were then compared in two tasks (color relevant, in which the color ink of words was identified, and word relevant in which words were classified as threatening or not). No emotional Stroop effect was observed in terms of longer RTs to identify the colors of threat words. ERP results provided valuable information about threat processing which was not observed with behavioral measures. Threat content was associated with larger P2 amplitude in the right than left hemisphere, and larger P3 amplitude, across tasks. The results indicate strong evidence for enhanced processing of threat-related stimuli in healthy individuals. It is concluded that ERPs are a sensitive measure of processes underlying emotional Stroop performance, which can be used to elucidate attentional biases in healthy and clinical populations.

Executive functions in obsessive-compulsive disorder: state or trait deficits?

OBJECTIVE

Despite the neuropsychology literature providing reliable evidence of impaired executive functions in obsessive-compulsive disorder (OCD), to date it has not been determined whether these deficits are trait-related (independent of symptomatology) or state-dependent (dependent on symptomatology). The current research examines the executive functions in OCD in a comprehensive manner and, for the first time, assesses the stability of these deficits over the developmental course of the disorder.

METHOD

Using a cross-sectional design, Study 1 examined the executive functions (set shifting, inhibition, planning, verbal fluency and working memory) in 60 subjects (20 actively Symptomatic OCD, 20 Remitted OCD and 20 Panic Disorder). Using a longitudinal design, Study 2 reassessed a subsample of OCD subjects (participants in Study 1) once they reached remitted status.

RESULTS

Study 1 found that the OCD groups exhibited deficits in set shifting and inhibition relative to Panic Disorder controls; however, no deficits were observed in planning, verbal fluency or working memory. There were no differences found between the Symptomatic and Remitted OCD groups on any of the executive function measures. Study 2 found that the identified executive function deficits in individuals were stable over time and remained unchanged despite symptom remittance.

CONCLUSION

Current results confirm the presence of specific executive function deficits in OCD, and indicate that these deficits are trait-like in nature.

Differential relations between heart rate and skin conductance, and public speaking anxiety

The present pilot study tested whether the lack of consistent findings of relations between autonomic nervous system (ANS) activity and non-clinical levels of public speaking anxiety (PSA) can be explained by methodology. An ambulatory protocol was utilised to test whether the interaction of belief structure with each of an undergraduate student speaker's heart rate and skin conductance level predicted state speech anxiety better than their linear summation. Results suggest that in a non-clinical population, the interaction of ANS activity and belief structure is an important determinant of PSA, and may account for variable findings in the literature.

Suppression of P50 evoked potential component, schizotypal beliefs and smoking

Suppression of the P50 component of the evoked potential is an electrophysiological index of sensory gating that is blunted in schizophrenia spectrum disorders. Although P50 suppression is thought to be related to symptomatology, this is yet to be shown. The failure to demonstrate this relation has led some to argue that P50 suppression and symptomatology are not related. However, a possible confound has recently been corroborated [i.e., chronic smoking is related to superior P50 suppression [Crawford et al., Neuroscience Letters 317 (2002) 151]], and a relation has been found in questionnaire-defined individuals with indications of schizotypy [i.e., psychometric schizotypy is related to poor P50 suppression [Croft et al., Biological Psychiatry 50 (2001) 441]]. The present study attempted to replicate and extend both studies by examining P50 suppression, smoking histories, psychometric schizotypy and NEO Five-Factor Inventory (NEO-V) scores in 37 healthy participants. Replicating Crawford et al., P50 suppression was better in the heavier smokers. Providing a partial replication of Croft et al., P50 suppression was inversely related to schizotypy scores in participants who smoked little or not at all; however, P50 suppression was positively related to schizotypy in heavier smokers. Covarying for age and NEO-V scale scores had little effect on these relations. The findings provide evidence of important confounds that would limit our ability to detect P50 suppression/symptom relations in schizophrenia.

Target-to-target interval versus probability effects on P300 in one- and two-tone tasks

The P3(00) is an electrophysiological index of neural processing that varies with such stimulus parameters as interstimulus interval (ISI) and target probability, with a common view being that it reflects an endogenous form of memory update. Building on previous research, we argue that relations between P3 amplitude and both ISI and probability may be attributable to the target-to-target interval (TTI). Employing between-subject (Experiment 1; N = 24) and within-subject (Experiment 2; N = 10) designs, the present paper addresses this by testing subjects on a standard two-tone auditory oddball task as well as a one-tone task. In both studies, P3 amplitude increased and latency decreased linearly with TTI, and these relations were relatively unaffected by ISI or probability. This suggests that ISI and probability per se do not independently affect P3 amplitude, and that TTI offers a strong explanation of the reported relations between P3 amplitude and both ISI and probability.

Target and non-target ERP disturbances in first episode vs. chronic schizophrenia

OBJECTIVES

Event-related potential (ERP) abnormalities to target stimuli are reliably found in schizophrenia. However, as people with schizophrenia are thought to have difficulty discerning the relevance of incoming sensory stimuli it is also important to examine ERPs to non-targets. To differentiate between potential trait markers of the disease and deficits that might be associated with the consequence of illness chronicity, this study investigated ERPs to both target and non-target stimuli in groups of people with either first episode or chronic schizophrenia (CSz).

METHODS

Using an auditory oddball paradigm, ERPs to target, non-target before target (Nt before) and non-target after target (Nt after) stimuli were analysed for 40 patients with CSz, 40 patients with first episode schizophrenia (FESz) and two groups of normal controls matched for age and sex with their patient counterparts.

RESULTS

The FESz group showed the same pattern of amplitude disturbance as the CSz group to both targets (reduced N100, N200, P300 and increased P200) and non-targets (reduced N100) compared to controls. Both CSz and FESz groups also failed to show the changes to the P200-N200 component between targets and non-target stimuli that was exhibited by controls (smaller earlier P200 to targets vs. increased delayed P200 to non-targets) or the reduction in N100 amplitude of ERPs to the Nt after stimuli compared with ERPs to the Nt before stimuli. Previous literature has focussed on the sensitivity of P300 deficits in classifying persons into schizophrenia and non-schizophrenia groups. This study demonstrated improved accuracy in the classification of patients with schizophrenia from controls using discriminant analysis of target and non-target N100 and P200 components.

CONCLUSIONS

The results suggest that ERP disturbances are evident at the time of first referral to mental health services and may be a potential trait (rather than secondary effect) of the illness. It is important to include both target and non-target stimuli processing, and their interrelationship in future research.

Response inhibition deficits in obsessive-compulsive disorder

Difficulty inhibiting irrelevant information may play a central role in the aetiology of obsessive-compulsive disorder (OCD). The aim of the present study was to determine whether OCD subjects (n=20) exhibit deficits in behavioural and cognitive inhibition compared with a clinical control group diagnosed with panic disorder (n=20). All subjects were administered a Go/Nogo task (a measure of behavioural inhibition) and a Stroop test (a measure of cognitive inhibition). OCD subjects made more commission errors on the Go/Nogo task, and they made more errors and displayed longer reaction times on the interference trial of the Stroop task. Trends towards correlations were observed between OCD severity scores and Stroop reaction time, where the more severe the OCD symptoms the faster was the response. No correlations between clinical symptomatology or subject demographics and the Go/Nogo task were observed. It was demonstrated that OCD subjects exhibit deficits in behavioural and cognitive inhibition, which together may underlie the repetitive symptomatic behaviours of the disorder, such as compulsions and obsessions.