Introduction

The present study investigates whether hypothesized cognitive mechanisms of change mediate the efficacy of cognitive-behavioral therapy (CBT) delivered online for treating depression and anxiety disorders. Articles were included by searching MEDLINE, PsychInfo and PsychArticles databases from January 1980 to March 2011. The inclusion criteria were as follows: (a) randomized clinical trials investigating the role of CBT delivered online, (b) patient sample had clinical or subclinical intensity emotional problems, (c) at least one measure of cognitions was included, (d) the inclusion of a control group, and (e) sufficient data provided to allow calculation of effect sizes. Eleven articles were selected. Results revealed a moderate overall effect size of CBT (d = .67, P < .05) on the combined cognitive and emotional outcomes. A positive impact of online CBT on cognitive factors (d = .69, P < .05) and emotional outcomes (d = .63, P < .05) was independently demonstrated. In conclusion, cognitive-behavioral therapy delivered online can be used as an efficacious treatment for patients with emotional disorders. Assuming causal effects, the data indicate that cognitive factors are an important mechanism of change in online CBT. Future online CBT focusing on changing cognitions are likely to be efficacious.     

A Computer-Integrated Approach to Program Evaluation

Abstract

Outcome evaluation of group work intervention in residential agencies. Development of a management/clinical information system and related computer applications.

Program evaluation as discussed in this article describes a service delivery-focused approach to program evaluation which is actually designed and implemented in a residential treatment agency for delinquent youth, the evaluation approach represents a practical strategy which applies much of the current thinking and research in the area of user focused evaluation. The approach has been refined by incorporating the product of the authors' experiential learning and pragmatic adaptations which evolved out of field testing the model over several years.

The authors present the overall approach to evaluation and the development of the evaluation model within an agency context. The author's then describe the development of a computer-based system which is designed to serve as both a management information system and a clinical information system. Basic aspects of the computer-based evaluation system are presented. Throughout the article, the authors discuss process-related issues pertaining to the introduction of evaluation to both management and staff and movement toward the implementation of an automated evaluation system.     

Integrating Pharmacotherapy and Psychosocial Interventions in the Treatment of Individuals with Alcohol Problems

Abstract

Both research and clinical experiences suggest that there are separate and overlapping benefits of medications and psychosocial treatments for alcohol problems. Evidence has shown that medication(s) combined with a moderate intensity psychosocial therapy can produce outcomes beyond what each of these approaches can produce alone. Taking medication can be helpful in facilitating longer periods of abstinence that in turn affords practitioners a greater opportunity to enhance patients' individual and social coping resources and to increase their motivation to change. Combining effective pharmacological and psychosocial interventions may provide the impetus to integrate alcoholism treatment into the general health care delivery system, thereby helping to increase the accessibility of care and well-being for individuals seeking or needing help with alcohol problems.     

Position Statement on Tobacco on College and University Campuses

Objective: The authors examined the feasibility of conducting serologic testing for the herpes simplex virus 2 (HSV-2) among university students and assessed the psychosocial impact of an HSV-2 diagnosis. Methods: The authors recruited a convenience sample of 100 students (aged 18-39 years) without a history of genital herpes from 1 university between September 2004 and March 2006. Participants received HSV-2 antibody testing by Focus ELISA and Western Blot assays and completed a questionnaire that addressed psychological functioning. Twenty-eight participants completed the questionnaire again at a 3-month follow-up visit. Results: The study revealed (1) low test-reliability in the student population, (2) that positive test results may cause a decline in psychological well-being, and (3) that substantial resources are required to support students with positive HSV-2 results. Conclusions: Test performance, psychological impact, and availability of resources for counseling students with positive diagnoses should be considered before implementing HSV testing programs.     

Are College Students More Disturbed Today? Stability in the Acuity and Qualitative Character of Psychopathology of College Counseling Center Clients: 1992-1993 Through 2001-2002

Are clients at college counseling centers more disturbed today than they were 5, 10, or 20 years ago? Since the mid-1980s, counseling center personnel have consistently perceived student clients as more distressed or reported acutely distressed clients as more prevalent than they did 1, 3, or 5 years ago. Only 3 studies employing a systematic, data-based methodology have addressed this question. Two researchers used different actuarial measures of the acuity or character of client pathology and concluded that current student clients are not more disturbed than were earlier ones. One researcher used clinical judgments rendered at the end of therapy and concluded that current students were more distressed. Using the Personality Assessment Inventory, the author found the actuarially determined quantitative and qualitative indices of pathology unchanged for 3,400 counseling center clients seen during 10 consecutive years. Over the same period, the use of medications increased fivefold. An actuarial measure of client distress appears crucial to both accurate diagnosis and treatment and to the adequate preparation of future counseling center professionals.     

Emotional Knowledge for Child Welfare Practice: Rediscovering Our Roots

Child protection is arguably in a state of crises, with indications that current approaches to practice are failing to protect children and support families. A variety of competing approaches have been put forward to address the current inadequacies, such as evidence‐based social work and antioppressive approaches to social work. These approaches to practice promote rational and technical analyses of social work with little attention to what lies beneath the surface in the encounter between social worker and client. In this paper we consider the value of psychoanalytic concepts for child protection practice. Notions of ambivalence, transference, and counter‐transference might offer a much needed source of insight for child protection practice that might help to address some of what has been lost in the field over the last few decades.     

The Psychotherapeutic Dimensions of Clinical Case Management with a Combat Veteran

This article addresses the overlapping dimensions of clinical case management and psychotherapy. The theoretical framework that is used as the basis of analysis is drawn from the work of D. W. and Clare Winnicott. Kanter has more than adequately demonstrated that these two authors were extremely knowledgeable about clinical case management and psychotherapy. The conclusion of the paper agrees with D. W. Winnicott (1961 Winnicott, D. W. 1961. “Varieties of psychotherapy.”. In Home is where we start from: Essays by a psychoanalyst, Edited by: Winnicott, C, Shepherd, R and Davis, M. 101–111. New York: Norton.  [Google Scholar]) who defined clinical case management as a variety of psychotherapy. The shared psychotherapeutic dimensions of clinical case management are identified as a focus on human development, the importance of the facilitating/holding environment and issues related to transference and countertransference.     

Clinical Trials of Drugs Used Off-Label in Neonates: Ethical Issues and Alternative Study Designs

The use of drugs for indications unapproved by the Food and Drug Administration (FDA), often called “off-label use,” is widespread in children, including neonates. The widespread off-label use of drugs in neonates presents ethical and safety challenges. Since the passage of the Best Pharmaceuticals for Children Act (BPCA) in 2002, both the FDA and National Institutes of Health (NIH) have taken initiatives to facilitate and encourage research to achieve the necessary labeling for drugs routinely used in infants and children. Federal regulations provide broad rules and guidance for the protection of human subjects in research. However, there are ethical issues that a physician may face when designing clinical trials of drugs in neonates that are routinely used off-label and widely believed to be beneficial. We attempt to describe these ethical challenges and provide recommendations, including alternative study designs, to resolve them in an ethical framework that takes into account the Belmont Report, the statement of the World Medical Association (WMA), and federal regulations.