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Clinical Psychology Research Paper


Bassam Khoury | Tania Lecomte | Guillaume Fortin | Marjolaine Masse | Phillip Therien | Vanessa Bouchard | Marie Andrée Chapleau | Karine Paquin | Stefan G. Hofmann

Background: Mindfulness-based therapy (MBT) has become a popular form of intervention. However, the existing reviews report inconsistent findings. Objective: To clarify these inconsistencies in the literature, we conducted a comprehensive effect-size analysis to evaluate the efficacy of MBT. Data sources: A systematic review of studies published in journals or in dissertations in PubMED or PsycINFO from the first available date until May 10, 2013. Review methods: A total of 209 studies (n= 12,145) were included. Results: Effect-size estimates suggested that MBT is moderately effective in pre-post comparisons (n= 72; Hedge's g= .55), in comparisons with waitlist controls (n= 67; Hedge's g= .53), and when compared with other active treatments (n= 68; Hedge's g= .33), including other psychological treatments (n= 35; Hedge's g= .22). MBT did not differ from traditional CBT or behavioral therapies (n= 9; Hedge's g= -. .07) or pharmacological treatments (n= 3; Hedge's g= .13). Conclusion: MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress. © 2013 Elsevier Ltd.


Jenny Gu | Clara Strauss | Rod Bond | Kate Cavanagh

© 2015 . Given the extensive evidence base for the efficacy of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), researchers have started to explore the mechanisms underlying their therapeutic effects on psychological outcomes, using methods of mediation analysis. No known studies have systematically reviewed and statistically integrated mediation studies in this field. The present study aimed to systematically review mediation studies in the literature on mindfulness-based interventions (MBIs), to identify potential psychological mechanisms underlying MBCT and MBSR's effects on psychological functioning and wellbeing, and evaluate the strength and consistency of evidence for each mechanism. For the identified mechanisms with sufficient evidence, quantitative synthesis using two-stage meta-analytic structural equation modelling (TSSEM) was used to examine whether these mechanisms mediate the impact of MBIs on clinical outcomes. This review identified strong, consistent evidence for cognitive and emotional reactivity, moderate and consistent evidence for mindfulness, rumination, and worry, and preliminary but insufficient evidence for self-compassion and psychological flexibility as mechanisms underlying MBIs. TSSEM demonstrated evidence for mindfulness, rumination and worry as significant mediators of the effects of MBIs on mental health outcomes. Most reviewed mediation studies have several key methodological shortcomings which preclude robust conclusions regarding mediation. However, they provide important groundwork on which future studies could build.


Matthew R. Sanders | James N. Kirby | Cassandra L. Tellegen | Jamin J. Day

This systematic review and meta-analysis examined the effects of the multilevel Triple P-Positive Parenting Program system on a broad range of child, parent and family outcomes. Multiple search strategies identified 116 eligible studies conducted over a 33-year period, with 101 studies comprising 16,099 families analyzed quantitatively. Moderator analyses were conducted using structural equation modeling. Risk of bias within and across studies was assessed. Significant short-term effects were found for: children's social, emotional and behavioral outcomes (d = 0.473); parenting practices (d = 0.578); parenting satisfaction and efficacy (d = 0.519); parental adjustment (d = 0.340); parental relationship (d = 0.225) and child observational data (d = 0.501). Significant effects were found for all outcomes at long-term including parent observational data (d = 0.249). Moderator analyses found that study approach, study power, Triple P level, and severity of initial child problems produced significant effects in multiple moderator models when controlling for other significant moderators. Several putative moderators did not have significant effects after controlling for other significant moderators. The positive results for each level of the Triple P system provide empirical support for a blending of universal and targeted parenting interventions to promote child, parent and family wellbeing. © 2013 Elsevier Ltd.


Kaidy Stautz | Andrew Cooper

Heightened impulsivity has been identified as a risk marker for excessive and problematic alcohol use, particularly during adolescence when impulsive behaviour is elevated and alcohol use is often initiated. Recent advances in personality theory indicate that impulsivity comprises several discrete traits which may influence alcohol use through different pathways. This review used meta-analysis to assess the degree to which the impulsivity-related traits of lack of premeditation, lack of perseverance, sensation seeking, negative urgency, positive urgency, and reward sensitivity are associated with alcohol consumption and problematic alcohol use in adolescent samples. All traits were positively associated with both alcohol outcomes. Sensation seeking and positive urgency showed the largest associations with alcohol consumption. Positive and negative urgency showed the largest associations with problematic alcohol use, although this was limited to older adolescent samples. A number of demographic and methodological variables were assessed as potential moderators of these associations. Results indicate that excessive alcohol consumption during adolescence may be driven in part by the desire to seek novel and exciting experiences. Problematic use, specifically amongst older adolescents, may be a consequence of a tendency to act rashly when in a heightened positive or negative mood. © 2013 Elsevier Ltd.


Daniel L. King | Maria C. Haagsma | Paul H. Delfabbro | Michael Gradisar | Mark D. Griffiths

Pathological video-gaming, or its proposed DSM-V classification of "Internet Use Disorder", is of increasing interest to scholars and practitioners in allied health disciplines. This systematic review was designed to evaluate the standards in pathological video-gaming instrumentation, according to Cicchetti (1994) and Groth-Marnat's (2009) criteria and guidelines for sound psychometric assessment. A total of 63 quantitative studies, including eighteen instruments and representing 58,415 participants, were evaluated. Results indicated that reviewed instrumentation may be broadly characterized as inconsistent. Strengths of available measures include: (i) short length and ease of scoring, (ii) excellent internal consistency and convergent validity, and (iii) potentially adequate data for development of standardized norms for adolescent populations. However, key limitations included: (a) inconsistent coverage of core addiction indicators, (b) varying cut-off scores to indicate clinical status, (c) a lack of a temporal dimension, (d) untested or inconsistent dimensionality, and (e) inadequate data on predictive validity and inter-rater reliability. An emerging consensus suggests that pathological video-gaming is commonly defined by (1) withdrawal, (2) loss of control, and (3) conflict. It is concluded that a unified approach to assessment of pathological video-gaming is needed. A synthesis of extant research efforts by meta-analysis may be difficult in the context of several divergent approaches to assessment. © 2013 Elsevier Ltd.


Mark D. Rapport | Sarah A. Orban | Michael J. Kofler | Lauren M. Friedman

Children with ADHD are characterized frequently as possessing underdeveloped executive functions and sustained attentional abilities, and recent commercial claims suggest that computer-based cognitive training can remediate these impairments and provide significant and lasting improvement in their attention, impulse control, social functioning, academic performance, and complex reasoning skills. The present review critically evaluates these claims through meta-analysis of 25 studies of facilitative intervention training (i.e., cognitive training) for children with ADHD. Random effects models corrected for publication bias and sampling error revealed that studies training short-term memory alone resulted in moderate magnitude improvements in short-term memory (d= 0.63), whereas training attention did not significantly improve attention and training mixed executive functions did not significantly improve the targeted executive functions (both nonsignificant: 95% confidence intervals include 0.0). Far transfer effects of cognitive training on academic functioning, blinded ratings of behavior (both nonsignificant), and cognitive tests (d= 0.14) were nonsignificant or negligible. Unblinded raters (d= 0.48) reported significantly larger benefits relative to blinded raters and objective tests (both p < .05), indicating the likelihood of Hawthorne effects. Critical examination of training targets revealed incongruence with empirical evidence regarding the specific executive functions that are (a) most impaired in ADHD, and (b) functionally related to the behavioral and academic outcomes these training programs are intended to ameliorate. Collectively, meta-analytic results indicate that claims regarding the academic, behavioral, and cognitive benefits associated with extant cognitive training programs are unsupported in ADHD. The methodological limitations of the current evidence base, however, leave open the possibility that cognitive training techniques designed to improve empirically documented executive function deficits may benefit children with ADHD. © 2013 Elsevier Ltd.


Michael J. Kofler | Mark D. Rapport | Dustin E. Sarver | Joseph S. Raiker | Sarah A. Orban | Lauren M. Friedman | Ellen G. Kolomeyer

Individuals with ADHD are characterized as ubiquitously slower and more variable than their unaffected peers, and increased reaction time (RT) variability is considered by many to reflect an etiologically important characteristic of ADHD. The present review critically evaluates these claims through meta-analysis of 319 studies of RT variability in children, adolescents, and adults with ADHD relative to typically developing (TD) groups, clinical control groups, and themselves (subtype comparisons, treatment and motivation effects). Random effects models corrected for measurement unreliability and publication bias revealed that children/adolescents (Hedges' g=. 0.76) and adults (g=. 0.46) with ADHD demonstrated greater RT variability relative to TD groups. This increased variability was attenuated by psychostimulant treatment (g=. -. 0.74), but unaffected by non-stimulant medical and psychosocial interventions. Individuals with ADHD did not evince slower processing speed (mean RT) after accounting for RT variability, whereas large magnitude RT variability deficits remained after accounting for mean RT. Adolescents and adults with ADHD were indistinguishable from clinical control groups, and children with ADHD were only minimally more variable than clinical control children (g=. 0.25). Collectively, results of the meta-analysis indicate that RT variability reflects a stable feature of ADHD and other clinical disorders that is robust to systematic differences across studies. © 2013 Elsevier Ltd.


Amitai Abramovitch | Jonathan S. Abramowitz | Andrew Mittelman

A vast and heterogeneous body of literature on the neuropsychology of obsessive-compulsive disorder (OCD) has accumulated in recent decades, yielding inconsistent results. In an attempt to quantitatively summarize the literature, we conducted a meta-analysis of 115 studies (including 3452 patients), comparing adult OCD patients with healthy controls on tests of 10 neuropsychological domains. Across studies, medium mean effect sizes were found for all executive function subdomains, processing speed, and sustained attention. Small effect sizes were found for visuospatial abilities and working memory. A large effect size was found for non-verbal memory whereas a small effect size was found for verbal memory, where only the former was found to be associated with impairments in executive functions. Moderators of effect sizes were also investigated. Results are discussed in terms of their clinical significance as well as their implications for current neurobiological models of OCD and methodological caveats. © 2013 Elsevier Ltd.


Alexander Winkler | Beate Dörsing | Winfried Rief | Yuhui Shen | Julia A. Glombiewski

Internet addiction (IA) has become a widespread and problematic phenomenon. Little is known about the efficacy of treatment approaches for IA. Therefore, our objective was to perform an effect size analysis of psychological and pharmacological interventions for IA. We conducted a literature search using PsycINFO, PSYNDEX, MEDLINE, EMBASE, PQDT OPEN, WorldCat, Cochrane Clinical Trials Library, and manual searches. Our meta-analysis was based on 16 studies, covered a total of 670 participants, and used a random effects model. Special emphasis was given to the inclusion of studies from "non-western" countries. Effect size estimates suggest that psychological and pharmacological interventions were highly effective for improving IA (g=1.61), time spent online (g=0.94), depression (g=0.90) and anxiety (g=1.25) from pre- to post-treatment in the overall sample. Moderator analyses revealed that studies including individual treatments, a higher number of female participants, older patients, or a North-American sample had larger effect sizes for some outcome variables. Most effect sizes were high, robust, unrelated to study quality or design, and maintained over follow-up. Due to a small number of included studies and methodological limitations the results of this meta-analysis should be regarded as preliminary. © 2012 Elsevier Ltd.


Jonathan S. Abramowitz | Laura E. Fabricant | Steven Taylor | Brett J. Deacon | Dean McKay | Eric A. Storch

Analogue samples are often used to study obsessive-compulsive (OC) symptoms and related phenomena. This approach is based on the hypothesis that results derived from such samples are relevant to understanding OC symptoms in individuals with a diagnosis of obsessive-compulsive disorder (OCD). Two decades ago, Gibbs (1996) reviewed the available literature and found initial support for this hypothesis. Since then there have been many important advances addressing this issue. The purpose of the present review was to synthesize various lines of research examining the assumptions of using analogue samples to draw inferences about people with OCD. We reviewed research on the prevalence of OC symptoms in non-clinical populations, the dimensional (vs. categorical) nature of these symptoms, phenomenology, etiology, and studies on developmental and maintenance factors in clinical and analogue samples. We also considered the relevance of analogue samples in OCD treatment research. The available evidence suggests research with analogue samples is highly relevant for understanding OC symptoms. Guidelines for the appropriate use of analogue designs and samples are suggested. © 2014 Elsevier Ltd.


Johan Ormel | Bertus F. Jeronimus | Roman Kotov | Harriëtte Riese | Elisabeth H. Bos | Benjamin Hankin | Judith G.M. Rosmalen | Albertine J. Oldehinkel

Neuroticism's prospective association with common mental disorders (CMDs) has fueled the assumption that neuroticism is an independent etiologically informative risk factor. This vulnerability model postulates that neuroticism sets in motion processes that lead to CMDs. However, four other models seek to explain the association, including the spectrum model (manifestations of the same process), common cause model (shared determinants), state and scar models (CMD episode adds temporary/permanent neuroticism). To examine their validity we reviewed literature on confounding, operational overlap, stability and change, determinants, and treatment effects. None of the models is able to account for (virtually) all findings. The state and scar model cannot explain the prospective association. The spectrum model has some relevance, especially for internalizing disorders. Common causes are most important but the vulnerability model cannot be excluded although confounding of the prospective association by baseline symptoms and psychiatric history is substantial. In fact, some of the findings, such as interactions with stress and the small decay of neuroticism's effect over time, are consistent with the vulnerability model. We describe research designs that discriminate the remaining models and plea for deconstruction of neuroticism. Neuroticism is etiologically not informative yet but useful as an efficient marker of non-specified general risk. © 2013 Elsevier Ltd.


Alberto Chiesa | Alessandro Serretti | Janus Christian Jakobsen

The beneficial clinical effects of mindfulness practices are receiving increasing support from empirical studies. However, the functional neural mechanisms underlying these benefits have not been thoroughly investigated. Some authors suggest that mindfulness should be described as a 'top-down' emotion regulation strategy, while others suggest that mindfulness should be described as a 'bottom-up' emotion regulation strategy. Current discrepancies might derive from the many different descriptions and applications of mindfulness. The present review aims to discuss current descriptions of mindfulness and the relationship existing between mindfulness practice and most commonly investigated emotion regulation strategies. Recent results from functional neuro-imaging studies investigating mindfulness training within the context of emotion regulation are presented. We suggest that mindfulness training is associated with 'top-down' emotion regulation in short-term practitioners and with 'bottom-up' emotion regulation in long-term practitioners. Limitations of current evidence and suggestions for future research on this topic are discussed. © 2012 Elsevier Ltd.


Pim Cuijpers | Marit Sijbrandij | Sander Koole | Marcus Huibers | Matthias Berking | Gerhard Andersson

Recent years have seen a near-doubling of the number of studies examining the effects of psychotherapies for generalized anxiety disorder (GAD) in adults. The present article integrates this new evidence with the older literature through a quantitative meta-analysis. A total of 41 studies (with 2132 patients meeting diagnostic criteria for GAD) were identified through systematic searches in bibliographical databases, and were included in the meta-analysis. Most studies examined the effects of cognitive behavior therapy (CBT). The majority of studies used waiting lists as control condition. The pooled effect of the 38 comparisons (from 28 studies) of psychotherapy versus a control group was large (g= 0.84; 95% CI: 0.71-0.97) with low to moderate heterogeneity. The effects based on self-report measures were somewhat lower than those based on clinician-rated instruments. The effects on depression were also large (g= 0.71; 95% CI: 0.59-0.82). There were some indications for publication bias. The number of studies comparing CBT with other psychotherapies (e.g., applied relaxation) or pharmacotherapy was too small to draw conclusions about comparative effectiveness or the long-term effects. There were some indications that CBT was also effective at follow-up and that CBT was more effective than applied relaxation in the longer term. © 2014 Elsevier Ltd.


Rebecca Grekin | Michael W. O'Hara

Research has demonstrated that women develop postpartum PTSD. Prevalence of postpartum PTSD has ranged from 1% to 30%, and many risk factors have been identified as predictors of postpartum PTSD. While qualitative reviews have identified patterns of risk, the lack of quantitative reviews prevents the field from identifying specific risk factors and making a single estimate of the prevalence of postpartum PTSD. The current meta-analysis investigated prevalence and risk factors of postpartum PTSD, both due to childbirth and other events, among community and targeted samples. Prevalence of postpartum PTSD in community samples was estimated to be 3.1% and in at-risk samples at 15.7%. Important risk factors in community samples included current depression, labor experiences such as interactions with medical staff, as well as a history of psychopathology. In at-risk samples, impactful risk factors included current depression and infant complications. Further research should investigate how attitudes towards pregnancy and childbirth may interact with women's experiences during delivery. Additionally, studies need to begin to evaluate possible long-term effects that these symptoms may have on women and their families. © 2014 Elsevier Ltd.


Scott O. Lilienfeld | Lorie A. Ritschel | Steven Jay Lynn | Robin L. Cautin | Robert D. Latzman

Psychotherapists are taught that when a client expresses resistance repeatedly, they must understand and address its underlying sources. Yet proponents of evidence-based practice (EBP) have routinely ignored the root causes of many clinical psychologists' reservations concerning the use of scientific evidence to inform clinical practice. As a consequence, much of the resistance to EBP persists, potentially widening the already large scientist-practitioner gap. Following a review of survey data on psychologists' attitudes toward EBP, we examine six sources underpinning resistance toward EBP in clinical psychology and allied domains: (a) naïve realism, which can lead clinicians to conclude erroneously that client change is due to an intervention itself rather than to a host of competing explanations; (b) deep-seated misconceptions regarding human nature (e.g., mistaken beliefs regarding the causal primacy of early experiences) that can hinder the adoption of evidence-based treatments; (c) statistical misunderstandings regarding the application of group probabilities to individuals; (d) erroneous apportioning of the burden of proof on skeptics rather than proponents of untested therapies; (e) widespread mischaracterizations of what EBP entails; and (f) pragmatic, educational, and attitudinal obstacles, such as the discomfort of many practitioners with evaluating the increasingly technical psychotherapy outcome literature. We advance educational proposals for articulating the importance of EBP to the forthcoming generation of clinical practitioners and researchers, and constructive remedies for addressing clinical psychologists' objections to EBP. © 2013 Elsevier Ltd.


Rebecca Waller | Frances Gardner | Luke W. Hyde

A growing body of research has examined callous-unemotional (CU) traits among samples of antisocial youth. Debate surrounds the malleability of CU traits and their responsiveness to parenting and parent-focused interventions. This review examines evidence from studies that have investigated various relationships between parenting, CU traits, and antisocial behavior (AB). Studies were categorized according to five distinct research questions each addressing associations among parenting, CU traits, and AB in a different way. The results suggest that dimensions of parenting are prospectively related to changes in CU traits. Subgroups of youth with both high levels of CU traits and AB also appear to have experienced negative parenting practices. However, negative parenting is not consistently related to AB in cross-sectional studies for youth with high levels of CU traits. At the same time, parenting-focused interventions appear effective in reducing the level of AB and CU traits in youth. The findings and implications for future studies are critically discussed as they pose challenges for current etiological theories of AB. © 2013.


Iliana Magiati | Xiang Wei Tay | Patricia Howlin

Background: Although increasing numbers of children diagnosed with Autism Spectrum Disorders (ASD) are now entering adolescence and adulthood, there is limited research on outcomes post childhood. A systematic review of the existing literature was conducted. Method: PsycINFO, PubMed, MedLine and CINAHL were systematically searched using keywords related to ASD and adolescent and adult outcomes. Studies of individuals diagnosed with ASD in childhood and followed up into adulthood were identified and reviewed. Only studies with samples sizes > . 10, mean age at outcome > . 16. years and at least one previous assessment in childhood ( < . 16. years) were included. Results: Twenty-five studies meeting criteria were identified. Reported outcomes in adulthood were highly variable across studies. Although social functioning, cognitive ability and language skills remained relatively stable in some studies, others reported deterioration over time. Adaptive functioning tended to improve in most studies. Diagnosis of autism or ASD was generally stable, although severity of autism-related behavioural symptoms was often reported to improve. Childhood IQ and early language ability appeared to be the strongest predictors of later outcome, but few studies examined other early variables associated with adult functioning. Discussion: Implications of the findings are discussed in relation to methodological challenges in longitudinal outcome research and future research directions. © 2013 Elsevier Ltd.


Joel Nigg

Attention-deficit/hyperactivity disorder (ADHD) is defined by extreme levels of inattention-disorganization and/or hyperactivity-impulsivity. In DSM-IV, the diagnostic criteria required impairment in social, academic, or occupational functioning. With DSM-5 publication imminent in 2013, further evaluation of impairment in ADHD is timely. This article reviews the current state of knowledge on health-related impairments of ADHD, including smoking, drug abuse, accidental injury, sleep, obesity, hypertension, diabetes, and suicidal behavior. It concludes by suggesting the need for new avenues of research on mechanisms of association and the potential for ADHD to be an early warning sign for secondary prevention of some poor health outcomes. © 2012 Elsevier Ltd.


Bianca Klettke | David J. Hallford | David J. Mellor

Career Research Paper: Clinical Psychology

894 Words4 Pages

Career Research Paper: Clinical Psychology
Clinical psychology is just one of the many subfields that psychology has to offer. Those who choose to enter clinical psychology aim to help people with addiction, emotional stress, mental illness, or any other type of mental problems. Knowing what a clinical psychologist does in their practice is important in understanding their profession. A clinical psychologist's education is the most prominent part of their career; without it, they cannot be considered a psychologist. The process and requirements of employment for psychologists are scattered, varying from state to state, as well as their salary and where they may be employed. The future and growth of clinical psychology can only be…show more content…

Career Research Paper: Clinical Psychology
Clinical psychology is just one of the many subfields that psychology has to offer. Those who choose to enter clinical psychology aim to help people with addiction, emotional stress, mental illness, or any other type of mental problems. Knowing what a clinical psychologist does in their practice is important in understanding their profession. A clinical psychologist's education is the most prominent part of their career; without it, they cannot be considered a psychologist. The process and requirements of employment for psychologists are scattered, varying from state to state, as well as their salary and where they may be employed. The future and growth of clinical psychology can only be determined by the success of this career today. My purpose for this paper is to research the education, the process and requirements of employment, plus the salary and places for employment for psychologists.
Clinical psychologists can treat a wide range of patients, from mental disorders to emotional problems. To get an easier and simpler idea of what a clinical psychologist does, Ferguson's Career Guidance Center's definition gives a good picture of a clinical psychologist’s job description, “Clinical psychologists concern themselves with people's mental and emotional disorders. They assess and treat problems ranging from normal psychological crises, such as adolescent rebellion or middle-age loss of self-esteem, to extreme conditions, such as

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