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CONTENTS
REGULAR ARTICLES
ABSTRACTS
SPECIAL SERIES:
This special series presents six different papers addressing the roles of implicit cognition and automatic processing in the treatment of psychopathology. Although each paper addresses a very different clinical population, the papers all offer concrete examples of how the study of implicit cognition may enhance real-world clinical assessment and treatment. In addition, they explain how cognitive psychology methods may be utilized to avoid response biases, identify dysfunctional cognitive processes, and specify the nature of mental representations in various disorders. The ultimate aim of this special series is to make a compelling case for translating research on implicit cognition into instruments and intervention techniques with clinical utility.
We outline an implicit cognition, verbal, and nonverbal assessment approach that is feasible for a range of interventions in health behavior and addiction. This approach provides a way to assess whether interventions have an influence on the relatively spontaneous memories, thoughts, and evaluations that may mediate or precipitate health-related behaviors (alcohol, tobacco, and other drug use; HIV risk behavior; diet, exercise, and violent acts). We focus on feasible assessment applications in relapse prevention, and briefly provide several examples of assessments also relevant to secondary prevention and media interventions, with a focus on addictive and HIV risk behaviors. The assessment examples range from well-investigated tests with grounding in basic research to assessments that have much promise for application but are yet to be thoroughly evaluated. The approach suggests that implicit cognition assessments may help practitioners uncover and address plausible cognitive mediation effects that are unlikely to be currently assessed.
There is a rich theoretical literature on the automatic nature of fear and anxiety and the role of maladaptive fear schemata. Information processing biases, both implicit and explicit, have been demonstrated among clinically anxious persons, but the clinical applications of this work have not been well developed. This article highlights empirical support for implicit cognition in anxiety (evaluating evidence for biases in attention, interpretation, memory, and automatic associations) and then focuses on the relevance of this research for clinical practice. Potential mechanisms for change in implicit cognition are outlined. Although clinical applications for implicit cognition are not yet well articulated, there is good reason to stay tuned to this research because recent advances in the study of automatic fear processing have potential to lead to better assessment and intervention techniques and better prediction of vulnerability to the onset and return of anxiety.
Cognitive theory has had a prominent role in understanding and treating eating disorders in recent years. The increasing emphasis on implicit cognitions in many areas of psychology raises the question of whether research on implicit cognitions could contribute to our understanding and treatment of eating disorders. In the present article, we discuss our recent work using the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) to explore implicit cognitions in restrained and unrestrained eaters. We also propose several domains in which exploring the utility of the IAT may prove beneficial. These include cognitive restructuring, inaccuracies in self-report, predicting relapse, body dissatisfaction, and treatment selection. Although there are numerous potential applications of the IAT for research and clinical practice with eating disorders, the value of these applications must be tested empirically.
Although extensive research has identified the role of consciously expressed cognition in the onset and maintenance of depression, much less work has directly examined the role of non-conscious, automatic, implicit cognition biases and depression. Further, whereas there is evidence of changes in self-report measures of cognition following cognitive therapy, there has been little work that identifies the specific therapeutic techniques that may directly modify nonconscious implicit cognition among depressed individuals. Improving our understanding of the role of implicit cognition in depression and how to manage these cognitive processes may help add to the efficacy of cognitive therapy. We review the literature examining the association between implicit cognition and depression and then describe potential therapeutic strategies for managing non-conscious implicit cognition biases in depression. Finally, we propose future directions of study, including a proposed cognitive-interpersonal framework for understanding therapeutic interactions in managing implicit cognition biases.
The most salient characteristic of the psychopath is the propensity to engage in maladaptive and inappropriate behavior of all sorts, including antisocial and criminal actions. Consequently, there is considerable interest—particularly in the field of criminology—in determining what sorts of treatment interventions are likely to be effective in modifying the problematic behavioral tendencies of this difficult population. We suggest that interventions are most likely to meet with success if they are based on an accurate understanding of the cognitive deficits that underlie psychopaths’ tendency to engage in maladaptive and illegal acts. Herein, we describe a theoretical framework for conceptualizing psychopaths’ information processing deficits (in which the concepts of automatic information processing and implicit cognition play central roles), then discuss implications of this formulation for the design and implementation of treatment interventions.
A number of learning-based interventions for problem drinking have emphasized the importance of behavioral self-control skills to help manage responses to high-risk cues. Self-management interventions typically have been based on the premise that effective self-regulation involves the use of conscious, controlled strategies to override habitual responses to high-risk cues. Recent developments in social cognition and health behavior research, however, have begun to expand our understanding of how automatic processes are involved in self-control. This research points to a number of ways that individuals may strategically use automatic processes to facilitate efforts to regulate problematic drinking behavior. Better understanding of these mechanisms holds the promise of advancing the development of assessment and self-management-based interventions for problem drinking. REGULAR ARTICLES
The primary aim of this article is to describe modifications made to Dialectical Behavior Therapy (DBT) for a predominantly ethnic minority population of persons living with HIV/AIDS with substance-use diagnoses and borderline personality disorder (BPD) or three features of BPD plus suicidality (i.e., the triply diagnosed). Despite the myriad psychosocial needs of the triply diagnosed, there remains a dearth of treatments available that can adequately address the challenges presented by these individuals’ dual diagnostic and HIV status. The key modifications we developed and describe in this article are (a) modification of Stage One, Target 2, behaviors to include HIV treatment adherence targets, 2) new and modified standard skills that address needs of the triply diagnosed client including methadone clinic–relevant skills and adherence skills; (c) expansion of the role of the therapist consultation group to include the DBT Therapist Path to HIV/AIDS Competence and HIV-related psychotherapy themes; and (d) use of a Consumer Advisory Board to provide consultation and feedback on treatment adaptations. A case study is presented that illustrates these modifications.
The first-line treatment for bulimia nervosa (BN), cognitive-behavioral therapy (CBT), uses food-based self-monitoring. Six young women presenting with BN or significant purging behavior were treated with a modification, Appetite-Focused CBT (CBT-AF), in which self-monitoring is based on appetite cues and food monitoring is proscribed. This change was designed to direct attention away from the typically excessive focus on type of food. Reinstating “moderate hunger” as the cue to eat and “moderate fullness” as the cue to stop discourages both severe restriction and overeating. Clients are encouraged to eat what they want (defined as what feels good internally) to prevent feelings of deprivation. The appetite monitoring component effectively targeted binge eating, essentially eliminating purging to compensate for binges, but purging that served other functions required additional interventions. Appetite monitoring was highly preferred compared to prior experiences with food monitoring. The results suggest that appetite monitoring is likely a viable alternative to food monitoring that may make CBT more acceptable for some individuals who binge and purge.
Therapists often struggle with managing intersession contact with clients diagnosed with borderline personality disorder, particularly when dangerous and life-threatening symptoms are communicated (Gunderson, 1996). Difficulties have arisen, in part, because previous phone contacts with this population have failed to recognize the importance of learning priniciples when assisting therapists in managing out-of-session contact with this population. Dialectical Behavior Therapy, a comprehensive, cognitive-behavior treatment, offers promise by providing structured telephone contacts with individuals diagnosed with borderline personality disorder that emphasize the role of learning principles (Linehan, 1993). This article describes the functions of DBT telephone coaching and describes several phone coaching techniques. In addition, five impediments are identified that therapists are likely to encounter when conducting and implementing DBT telephone coaching. Solutions to overcoming these impediments are addressed using the DBT model as a reference.
The promotion and dissemination of empirically supported (ESTs) and manualized therapies are important, albeit controversial, developments within clinical science and practice. To date, studies evaluating training opportunities and attitudes about such treatments at the graduate, predoctoral internship, and postdoctoral levels have focused on the opinions of training directors and seasoned practitioners. The present study surveyed 172 graduate students from 60 APA-accredited doctoral programs in clinical, counseling, and school psychology regarding their knowledge, extent of didactic and practical training experiences, and attitudes about ESTs and treatment manuals. Student knowledge of, and attitudes about, treatment manuals and ESTs varied reliably as a function of self-described theoretical orientation (i.e., cognitive behavioral vs. eclectic) and extent of didactic and applied training experiences. Graduate education and training in ESTs and treatment manuals predicted plans to use and seek out additional training with such methods. We recommend that graduate programs increase efforts to promote, disseminate, and integrate these and other evidentiary procedures into their training curricula.
For the past 10 years, the first author has been using therapeutic stories with a wide variety of children in an outpatient, private practice setting. Clinical findings have suggested that this Therapeutic Storytelling Technique (TST) may be a useful addition to the armamentarium of the cognitive-behavioral child therapist. The present article provides a detailed description of the theory, rationale, and procedural components of TST. Finally, the TST approach is further illustrated by means of a formal case study and sample story vignettes. It is hoped that the current work will lead to well-controlled, larger-scale research efforts to further delineate the usefulness of this promising technique.
While the existing research consistently points to the effectiveness of Dialectical Behavior Therapy (DBT) in treating borderline personality disorder, little qualitative research has been conducted to ascertain the reasons for its success, especially from the perspective of those undergoing the treatment. Our qualitative investigation was undertaken with the goal of understanding, from the perspective of the client, what is effective about DBT and why. We interviewed 14 clients who were involved in a DBT program run by Assertive Community Treatment (ACT) of Kalamazoo, Inc. All of the women interviewed reported that DBT had a positive impact on their lives. |
Introduction