Working Alliance Inventory‐Short Revised (WAI‐SR): psychometric properties in outpatients and inpatients

The Working Alliance Inventory‐Short Revised (WAI‐SR) is a recently refined measure of the therapeutic alliance that assesses three key aspects of the therapeutic alliance: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond. The WAI‐SR demonstrated good psychometric properties in an initial validation in psychotherapy outpatients in the USA. The generalizability of these findings is limited because in some countries a substantial portion of individual psychotherapy is delivered in inpatient settings. This study investigated and compared the psychometric properties of the WAI‐SR in German outpatients (N = 88) and inpatients (N = 243). In both samples reliability (? ? 0.80) and convergent validity with the Helping Alliance Questionnaire were good (r > 0.64). Confirmatory factor analysis showed acceptable to good model fit for the proposed Bond‐Task‐Goal model in both samples. Multi‐group analysis demonstrated that the same constructs were measured across settings. Alliance ratings of outpatients and inpatients differed regarding the overlap of alliance components and the magnitude of the alliance ratings: The differentiation of the alliance components was poorer in inpatients and they reported lower alliances. Unique aspects of the alliance in inpatient treatment are discussed and a need for further research on the alliance in inpatient settings is pointed out. Overall, the WAI‐SR can be recommended for alliance assessment in both settings. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message

• The Working Alliance Inventory‐Short Revised (WAI‐SR) is a 12‐item measure for the assessment of the therapeutic alliance.
• The WAI‐SR is pantheoretic and captures three key alliance aspects: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond.
• This study demonstrates good psychometric properties of the WAI‐SR in outpatients and inpatients.
• The WAI‐SR is ready to be used by psychotherapists interested in the therapeutic alliance, for supervision and process research.

     

Enduring effects of evidence-based psychotherapies in acute depression and anxiety disorders versus treatment as usual at follow-up — A longitudinal meta-analysis

Objective

This meta-analysis examined the enduring efficacy of evidence-based psychotherapies (EBP) in comparison to treatment as usual (TAU) by examining effects from termination to follow-up for acute anxiety and depression in an adult outpatient population. It was hypothesized that EBPs might extend their efficacy at follow-up assessment (Tolin, 2010).

Method

Longitudinal multilevel meta-analyses were conducted that examined the magnitude of difference between EBP and TAU. Targeted (disorder-specific) outcomes were examined, along with dropout rates at follow-up assessments.

Results

A total of 15 comparisons (including 30 repeated effect sizes [ES]) were included in this meta-analysis (average of 8.9 month follow-up). Small to moderate ES differences were found to be in favor of EBPs at 0–4 month assessments (Hedges' g = 0.40) and up to 12–18 month assessments (g = 0.20), indicating no extended efficacy at follow-up. However, the TAU-conditions were heterogeneous, ranging from absence of minimal mental health treatment to legitimate psychotherapeutic interventions provided by trained professionals, the latter of which resulted in smaller ES differences. Furthermore, samples where substance use comorbidities were not actively excluded indicated smaller ES differences. TAU-conditions produced slightly higher dropout rates than EBP-conditions.

Conclusion

Findings indicate small and no extended superiority of EBP for acute depression and anxiety disorders in comparison to TAU at follow-up assessment. There are a limited number of studies investigating the transportability and lasting efficacy of EBP compared to TAU, especially to TAU with equivalent conditions between treatment groups.     

A modified therapeutic option for a long lasting success in the treatment of genital lymphedema

In cases of chronic genital lymphedema with an excessive proliferation of scrotal or labial tissue, lymph cysts, and fistulae, complex decongestive therapy (CDT) alone is not enough. After decongestion has been achieved by CDT, a major reconstructive procedure followed by a renewed phase of CDT is required. We report on our good cosmetic and functional long-time results achieved in 24 patients suffering from lymphedema of the genitalia treated by this combination of conservative CDT and surgery. In 17 male patients (16 primary and one secondary lymphedema), reduction of the scrotum was performed. Bilateral reduction of the labia was carried out in seven female patients (five secondary and two primary lymphedema). The mean follow-up was 67.8 months (36–84 months). The etiology of the lymphedema had no effect on the operation procedure or the operative outcome.An invited commentary on this paper is available at .     

Role of arginase in asthma: potential clinical applications

Allergic asthma is a chronic disease with significant morbidity and mortality. It affects 300 million people worldwide and absorbs a significant amount of the healthcare budget. The predisposition to asthma is dictated by complex genetic regulation, and the asthmatic inflammation itself is characterized by the interplay of various local cells of the bronchial tree and invading inflammatory immune cells. The clinical problems of asthma are owing to intermittent airway hyper-responsiveness that can become chronic in the course of the disease. Histopathologically, infiltration with a variety of inflammatory cells, smooth muscle cell hyperplasia and hypertrophy, goblet cell hyperplasia and subepithelial fibrosis are found in asthmatic inflammatory tissue. This special report sets out to review data on the role of the enzyme arginase and L-arginine metabolism as a unifying element of asthma pathophysiology and as a potential target for future clinical asthma treatment.     

Über den Einfluß verschiedener Kunststoff-Monomere auf den Zellstoffwechsel—gemessen am Sauerstoffverbrauch

Zusammenfassung Als zweiten Beitrag über das biologische Verhalten von Kunststoff-Monomeren und primären Polymerisaten wurde die Wirkung von 1%igen Monomer-Suspensionen auf den Zellstoffwechsel untersucht.Mit Hilfe derpolarographischen Meßmethode wurde der O₂-Verbrauch von Mäuse-Ascites-Ehrlich-Tumorzellen in Krebs-Ringer-Phosphatlösung sowie Humanblut-Leukocyten aus Citratplasma gemessen und dessenHemmung nach Zusatz der Monomer-Suspensionen ermittelt. Es ergaben sich stark variierende Werte, je nach Art des Monomers, die zwischen 18% und 80% O₂-Hemmung lagen.Mit 2 Textabbildungen     

Primary antibody formation in vitro by mouse cells in a complete homologous system

Mouse lymphocytes have been cultivated in the absence of heterologous sera or mitogenic compounds. The fetal calf serum usually used was replaced by small amounts (0.5–1 mg protein/ml medium) of homologous exudate fluid induced by intraperitoneal injection of lysolecithin. Under these conditions, a primary immune response against various antigens (sheep red blood cells, dinitrophenyl-dextran, dinitrophenyl-human IgG) can be elicited. Adjuvant activity of lysolecithin has also been studied in this system.     

SAMHD1 in cancer: curse or cure?

Journal of Molecular Medicine - Human sterile α motif and HD domain-containing protein 1 (SAMHD1), originally described as the major cellular deoxyribonucleoside triphosphate...