Case complexity as a guide for psychological treatment selection. Journal of Consulting and Clinical Psychology, 85 (9). pp. 835-853. ISSN 0022-006X https://doi.org/10.1037/ccp0000231 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. AbstractObjective: Some cases are thought to be more complex and difficult to treat, although there is little consensus on how to define complexity in psychological care. This study proposes an actuarial, data-driven method of identifying complex cases based on their individual characteristics.Method: Clinical records for 1512 patients accessing low and high intensity psychological treatments were partitioned in 2 random subsamples. Prognostic indices (PI) predicting post-treatment reliable and clinically significant improvement (RCSI) in depression (PHQ-9) and anxiety (GAD-7) symptoms were estimated in one subsample using penalized (Lasso) regressions with optimal scaling. A PI-based algorithm was used to classify patients as standard (St) or complex (Cx) cases in the second (cross-validation) subsample. RCSI rates were compared between Cx cases that accessed treatments of different intensities using logistic regression.Results: St cases had significantly higher RCSI rates compared to Cx cases (OR = 1.81 to 2.81). Cx cases tended to attain better depression outcomes if they were initially assigned to high intensity (vs. low intensity) interventions (OR = 2.23); a similar pattern was observed for anxiety but the odds ratio (1.74) was not statistically significant. Conclusions:Complex cases could be detected early and matched to high intensity interventions to improve outcomes. 3What is the public health significance of this article?Complex cases tend to have a poor prognosis after psychological treatment for depression and anxiety problems. An evidence-based model of defining complexity is proposed to guide therapists in matching patients to treatments of differing intensity. The findings indicate that this personalized method of treatment selection could lead to better outcomes for complex cases and could improve upon decisions that are informed by clinical judgment alone.

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Recent research into reason giving for depression has illustrated the importance of client beliefs about the cause of their depression. Reasons given have been found to be associated with level of depression, perceived credibility of treatments and therapy outcome. It has been suggested that giving reasons for depression is a form of rule-governed behaviour and as such can cause the depression to be harder to treat (i.e. the reasons become functionally true for the individual). This study investigates the reliability and validity of the Reasons for Depression Questionnaire (RFD; Addis, Truax, & Jacobson, 1995), a 48-item self-report measure developed to measure explanations for the causes of depression. The study provides preliminary normative data for both clinical (n = 123) and non-clinical (n = 105) UK samples. The data indicate high reliability for all subscales including a further subscale (biological) added since the measure was initially developed. Certain subscales correlate significantly with level of depression and specific aspects of self-esteem. This supports the validity of the measure and suggests that it is measuring a distinct concept rather than significantly overlapping with individuals' general beliefs about themselves.

Clinical psychologists, like most health professionals, are in essence clinical problem-solvers. However, dealing with mental health problems may necessitate a greater relative reliance upon inductive clinical reasoning during the problem-solving process. To develop a provisional problem formulation mental health professionals may have to make sense of the co-occurrence of complex and poorly delineated problems. Claims have been made, predominantly in the literature on medical education, regarding the utility of problem-based learning (PBL) for achieving aims central to the effective performance of this role. In this article, after characterizing clinical psychology and PBL, we briefly explore the benefits claimed for PBL and assert that the putative cognitive and interpersonal consequences of the approach may be particularly pertinent to mental health practice. Particular emphasis is placed upon the necessity of facilitating effective clinical reasoning, that is, teaching future practitioners how to, rather than what to, think about complex psychopathology. PBL is also considered in the wider context of models of experiential learning and methods for teaching problem-solving. Finally, future research questions are suggested which may provide answers relevant to the facilitation of effective clinical reasoning in all health professions.

The purpose of this paper is to provide an introduction to the profession of clinical psychology. We provide a definition and overview of the core features of the profession, followed by a description of entry requirements and education. We go on to describe the dominant models which have driven the training and practice of clinical psychologists through the latter half of the 20th century to the present day. We conclude with a look to the future of the profession and a brief consideration of opportunities and threats. Throughout we have attempted to pick out aspects of the profession that are relevant or of interest, irrespective of national differences in professional training and practice, or variations in the development of clinical psychology in particular nation states. When generalisations would be too broad to be useful or are otherwise difficult, we have provided specific information about the profession as it has developed in the UK or USA. The references should provide a rich source of further information for the interested reader.