Client preferences in psychotherapy reflect specific conditions and activities that clients desire in their treatment, with increasing evidence pointing to preference accommodation as facilitating ...psychotherapy outcomes. This updated meta‐analysis establishes the magnitude of the effect of client preference accommodation in psychotherapy. Based on data from 53 studies and over 16,000 clients, preference accommodation was associated with fewer treatment dropouts (OR = 1.79) and more positive treatment outcomes (d = 0.28) than providing client with a nonpreferred treatment or psychotherapy condition. The preference effect was moderated by study design, timing and type of outcome measurement, and client diagnosis. It was not moderated by year of publication, treatment duration, preference type, treatment options, client age, client gender, client ethnicity, or client years of education. The authors provide a case example of preference accommodation and practice recommendations for working with client preferences.
Abstract Nearly twice as many participants are represented in the current literature than were available at the time of the last major meta-analytic neurocognitive examination of apolipoprotein E ...(ApoE) epsilon allele combinations Small, B.J., Rosnick, C.B., Fratiglioni, L., Backman, L., 2004. Apolipoprotein E and cognitive performance: a meta-analysis. Psychol. Aging 19, 592–600. The meta-analysis in the current study sought to specifically examine (1) small effects and (2) possible moderating variables associated with ApoE allele combinations that may have been undiscoverable in previous examinations of smaller data sets. A total of 77 studies, representing 40,942 cognitively healthy adults were identified for inclusion in the current meta-analysis (random effects design). Results were congruent with the previous meta-analytic findings indicating that carriers of ApoE allele 4 (ε4) perform significantly worse on measures of episodic memory, executive functioning, and overall global cognitive ability. In addition, the current analysis revealed a small effect suggesting that ApoE allele 4 adversely impacts perceptual speed. In contrast to earlier studies, the results also indicate that increases in age result in significantly larger differences between ApoE ε4 carriers and ApoE non-ε4 carriers on measures of episodic memory and global cognitive ability. ApoE ε4 exerts broad, but specific, adverse small effects on a range of neurocognitive functions in cognitively healthy adults.
Relatlimab and nivolumab combination immunotherapy improves progression-free survival over nivolumab monotherapy in patients with unresectable advanced melanoma
. We investigated this regimen in ...patients with resectable clinical stage III or oligometastatic stage IV melanoma (NCT02519322). Patients received two neoadjuvant doses (nivolumab 480 mg and relatlimab 160 mg intravenously every 4 weeks) followed by surgery, and then ten doses of adjuvant combination therapy. The primary end point was pathologic complete response (pCR) rate
. The combination resulted in 57% pCR rate and 70% overall pathologic response rate among 30 patients treated. The radiographic response rate using Response Evaluation Criteria in Solid Tumors 1.1 was 57%. No grade 3-4 immune-related adverse events were observed in the neoadjuvant setting. The 1- and 2-year recurrence-free survival rate was 100% and 92% for patients with any pathologic response, compared to 88% and 55% for patients who did not have a pathologic response (P = 0.005). Increased immune cell infiltration at baseline, and decrease in M2 macrophages during treatment, were associated with pathologic response. Our results indicate that neoadjuvant relatlimab and nivolumab induces a high pCR rate. Safety during neoadjuvant therapy is favourable compared to other combination immunotherapy regimens. These data, in combination with the results of the RELATIVITY-047 trial
, provide further confirmation of the efficacy and safety of this new immunotherapy regimen.
Objective: Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high ...comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. Method: The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. Results: Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed. Conclusions: HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility.
What is the public health significance of this article?
Redefining a taxonomy of psychopathology according to data results in dimensions, not categories, that can be organized hierarchically-with at least six higher level spectra near the top of the model and more specific lower level components and traits at the bottom. This approach may improve case conceptualizations and align more closely with transdiagnostic treatments, while also specifying more narrow targets for intervention. A case illustration shows how the HiTOP model can be used in clinical practice today, although additional research is needed to fully assess the utility of this approach for providers and patients.
Combination immune checkpoint blockade has demonstrated promising benefit in lung cancer, but predictors of response to combination therapy are unknown. Using whole-exome sequencing to examine ...non-small-cell lung cancer (NSCLC) treated with PD-1 plus CTLA-4 blockade, we found that high tumor mutation burden (TMB) predicted improved objective response, durable benefit, and progression-free survival. TMB was independent of PD-L1 expression and the strongest feature associated with efficacy in multivariable analysis. The low response rate in TMB low NSCLCs demonstrates that combination immunotherapy does not overcome the negative predictive impact of low TMB. This study demonstrates the association between TMB and benefit to combination immunotherapy in NSCLC. TMB should be incorporated in future trials examining PD-(L)1 with CTLA-4 blockade in NSCLC.
•High TMB correlates with efficacy of PD-1 plus CTLA-4 blockade in NSCLC•TMB and PD-L1 are independent variables•In multivariate analysis, TMB associated most strongly with efficacy
Hellmann et al. examine non-small-cell lung cancers treated with combined PD-1 and CTLA-4 blockade using whole-exome sequencing and find that high tumor mutation burden is the strongest feature associated with improved objective response, durable benefit, and progression-free survival in multivariable analysis.
Within the first few months of the COVID-19 pandemic, JPI issued a call for scholarship to inform psychotherapy with those facing long-term adverse impacts (e.g., economic insecurity or deep ...poverty). This issue brings together a sampling of responses spanning the variety of ways in which psychotherapists and researchers are prepared to respond and underscores the need to attend to social determinants of health.
Public Health Significance StatementPandemic adversities are fundamentally intertwined with social determinants of health. As we enter the third year of the COVID-19 pandemic, inequalities of adverse impact have become readily apparent. Psychotherapists play an important role in mitigating declines in well-being among those most vulnerable.
Comments on an article by C. J. Gonsalvez et al. (see record 2020-42986-001). Gonsalvez et al. are strong contributors to addressing the need for measures of competency, publishing several studies ...over the past 15 years that provide empirical investigation of supervisors' ratings of trainees' practicum competencies. Given the programmatic line of inquiry into this measure, the context of the earlier paper and commentaries greatly enriches our understanding of the role and contribution of this latest installment of measure development work. It also underscores the need for the field to accelerate research in this area. In this most recent installment of their work, Gonsalvez and colleagues also report that two mega-clusters of competencies emerged, regardless of whether a random or fixed order item administration sequence was used. Those spectra again appear to generally reflect foundational and functional components of broad, overarching, competency. In this way, Gonsalvez' work on the structure of competency, and idiosyncratic labeling, is perhaps not to be taken as meaningfully speaking to the anatomy of competency as a construct beyond this measure. The conclusion in that regard is not intended to speak ill of the measure; it is simply a statement that any measure of a construct is influenced by the items written to tap into the construct. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Racial and ethnic diversity constriction in the psychology training-to-workforce pipeline has been broadly identified at the undergraduate, graduate, and licensure levels. Within that context, the ...present study sought to investigate the rate at which racial and ethnic minority students matched for internship compared to majority non-Hispanic White graduate students. Consistent with prior reports, racial and ethnic minority students were significantly underrepresented in clinical psychology doctoral programs. However, internship match rates did not differ significantly by racial and ethnic minority status. Placed within the larger context of established literature, the findings suggest that internship match is not likely to be a significant contributor to the constriction of racial/ethnic diversity in the training-to-workforce pipeline. As an exception to the problem, other points in the training-to-workforce pipeline that have been identified as points of diversity constriction (e.g., doctoral recruitment and admissions, licensure) may benefit from careful consideration of internship application criteria and/or review processes in formulating constriction remediation plans. Programmatic remediation of underrepresented minorities can lead to several gains for the profession, including improved educational outcomes; improved leadership and critical thinking skills; and increased openness and tolerance for racial, cultural, and value diversity.
Public Significance Statement
With declines in representation in the range of 50%-70%, diversity constriction of underrepresented minorities (i.e., Hispanic/Latinx; Black/African American individuals; Native American) is a pernicious problem within clinical psychology for which discipline-level remediation seems appropriate. Points of known constriction, such as doctoral recruitment and admissions and examination for licensure, are encouraged to learn from the more effective methods and processes of internship match to foster greater inclusiveness and equity.
It remains uncertain whether people with psychotic disorders experience progressive cognitive decline or normal cognitive aging after first hospitalization. This information is essential for ...prognostication in clinical settings, deployment of cognitive remediation, and public health policy.
To examine long-term cognitive changes in individuals with psychotic disorders and to compare age-related differences in cognitive performance between people with psychotic disorders and matched control individuals (ie, individuals who had never had psychotic disorders).
The Suffolk County Mental Health Project is an inception cohort study of first-admission patients with psychosis. Cognitive functioning was assessed 2 and 20 years later. Patients were recruited from the 12 inpatient facilities of Suffolk County, New York. At year 20, the control group was recruited by random digit dialing and matched to the clinical cohort on zip code and demographics. Data were collected between September 1991 and July 2015. Analysis began January 2016.
Change in cognitive functioning in 6 domains: verbal knowledge (Wechsler Adult Intelligence Scale-Revised vocabulary test), verbal declarative memory (Verbal Paired Associates test I and II), visual declarative memory (Visual Reproduction test I and II), attention and processing speed (Symbol Digit Modalities Test-written and oral; Trail Making Test TMT-A), abstraction-executive function (Trenerry Stroop Color Word Test; TMT-B), and verbal fluency (Controlled Oral Word Association Test).
A total of 705 participants were included in the analyses (mean SD age at year 20, 49.4 10.1 years): 445 individuals (63.1%) had psychotic disorders (211 with schizophrenia spectrum 138 (65%) male; 164 with affective psychoses 76 (46%) male; 70 with other psychoses 43 (61%) male); and 260 individuals (36.9%) in the control group (50.5 9.0 years; 134 51.5% male). Cognition in individuals with a psychotic disorder declined on all but 2 tests (average decline: d = 0.31; range, 0.17-0.54; all P < .001). Cognitive declines were associated with worsening vocational functioning (Visual Reproduction test II: r = 0.20; Symbol Digit Modalities Test-written: r = 0.25; Stroop: r = 0.24; P < .009) and worsening negative symptoms (avolition: Symbol Digit Modalities Test-written: r = -0.24; TMT-A: r = -0.21; Stroop: r = -0.21; all P < .009; inexpressivity: Stroop: r = -0.22; P < .009). Compared with control individuals, people with psychotic disrders showed age-dependent deficits in verbal knowledge, fluency, and abstraction-executive function (vocabulary: β = -0.32; Controlled Oral Word Association Test: β = -0.32; TMT-B: β = 0.23; all P < .05), with the largest gap among participants 50 years or older.
In individuals with psychotic disorders, most cognitive functions declined over 2 decades after first hospitalization. Observed declines were clinically significant. Some declines were larger than expected due to normal aging, suggesting that cognitive aging in some domains may be accelerated in this population. If confirmed, these findings would highlight cognition as an important target for research and treatment during later phases of psychotic illness.
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