Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive ...disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.
•Practicability, negative beliefs, and therapist distress as barriers of exposure.•High agreement was found for single barriers within each of the three categories.•Higher agreement for practicability than negative beliefs than therapist distress.•Practicability and negative beliefs associated with self-reported use of exposure.•Exposure dissemination requires targeting individual, practical, systemic barriers.
L. K. Jakobsen, K. F. Trelborg, P. S. Kingo, S. Høyer, K.-E. Andersson, J. C. Djurhuus, R. Nørregaard, L. H. Olsen.
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The expression of aquaporins (AQPs ) in the fetal porcine urinary ...tract and its relation to gestational age has not been established. Tissue samples from the renal pelvis, ureter, bladder and urethra were obtained from porcine fetuses. Samples were examined by RT-PCR (AQPs 1-11 ), QPCR (AQPs positive on RT-PCR), and immunohistochemistry. Bladder samples were additionally examined by Western blotting. RNA was extracted from 76 tissue samples obtained from 19 fetuses. Gestational age was 60 (n=11) or 100 days (n=8). PCR showed that AQP1, 3, 9 and 11 mRNA was expressed in all locations. The expression of AQP3 increased significantly at all four locations with gestational age, whereas AQP11 significantly decreased. AQP1 expression increased in the ureter, bladder and urethra. AQP9 mRNA expression increased in the urethra and bladder, but decreased in the ureter. AQP5 was expressed only in the urethra. Immunohistochemistry showed AQP1 staining in sub-urothelial vessels at all locations. Western blotting analysis confirmed increased AQP1 protein levels in bladder samples during gestation. Expression levels of AQP1, 3, 5, 9 and 11 in the urinary tract change during gestation, and further studies are needed to provide insights into normal and pathophysiological water handling mechanisms in the fetus.
New technologies such as Internet of Things (IoT), Augmented Reality (AR), Virtual Reality (VR), Mixed Reality (MR), virtual assistants, chatbots, and robots, which are typically powered by ...Artificial Intelligence (AI), are dramatically transforming the customer experience. In this paper, we offer a fresh typology of new technologies powered by AI and propose a new framework for understanding the role of new technologies on the customer/shopper journey. Specifically, we discuss the impact and implications of these technologies on each broad stage of the shopping journey (pre-transaction, transaction, and post-transaction) and advance a new conceptualization for managing these new AI technologies along customer experience dimensions to create experiential value. We discuss future research ideas emanating from our framework and outline interdisciplinary research avenues.
•The impact of new technologies on the stages of the customer journey.•The impact on type of customer experience (cognitive, sensory/emotional, social).•Important potential moderators for the customer journey.•Important potential moderators for creating experiential value.•Some interdisciplinary research avenues.
Objective:Pharmacotherapy, cognitive-behavioral therapy (CBT), and psychodynamic therapy are most frequently applied to treat mental disorders. However, whether psychodynamic therapy is as ...efficacious as other empirically supported treatments is not yet clear. Thus, for the first time the equivalence of psychodynamic therapy to treatments established in efficacy was formally tested. The authors controlled for researcher allegiance effects by including representatives of psychodynamic therapy and CBT, the main rival psychotherapeutic treatments (adversarial collaboration).Method:The authors applied the formal criteria for testing equivalence, implying a particularly strict test: a priori defining a margin compatible with equivalence (g=0.25), using the two one-sided test procedure, and ensuring the efficacy of the comparator. Independent raters assessed effect sizes, study quality, and allegiance. A systematic literature search used the following criteria: randomized controlled trial of manual-guided psychodynamic therapy in adults, testing psychodynamic therapy against a treatment with efficacy established for the disorder under study, and applying reliable and valid outcome measures. The primary outcome was “target symptoms” (e.g., depressive symptoms in depressive disorders).Results:Twenty-three randomized controlled trials with 2,751 patients were included. The mean study quality was good as demonstrated by reliable rating methods. Statistical analyses showed equivalence of psychodynamic therapy to comparison conditions for target symptoms at posttreatment (g=−0.153, 90% equivalence CI=−0.227 to −0.079) and at follow-up (g=−0.049, 90% equivalence CI=−0.137 to −0.038) because both CIs were included in the equivalence interval (−0.25 to 0.25).Conclusions:Results suggest equivalence of psychodynamic therapy to treatments established in efficacy. Further research should examine who benefits most from which treatment.
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