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Experiencing a thought about harming or injuring another person is commonly reported by the general population. Aggressive intrusive thoughts (AITs) and aggressive scripts are two constructs commonly used to define the experience of thinking about harming another person. However, they are generally investigated separately and with two significantly different population groups; respectively, individuals with obsessive-compulsive disorder and people with a history of violent behavior. AITs and aggressive scripts are assumed to have very different implications for violence risk assessment, but conceptual overlap and an absence of empirical research renders this assumption premature. Using a battery of self-report measures, this study aimed to investigate the differential predictors of AITs and aggressive script rehearsal in a nonclinical sample. Additionally, using regression analyses, the predictors of self-reported aggressive behavior were explored in a sample of 412 adults (73% females; M

Previous studies have demonstrated inconsistency in the effectiveness of staff training programs in consumer directed care (CDC) as a means of enhancing the quality of life (QoL) of residents. The aim of this study was to investigate why this might be the case. We analyzed disaggregated cluster-by-cluster resident QoL outcomes after nursing home staff completed a CDC training program. In total, 33 nursing homes (11 clusters) participated in the study. As with previous studies, the outcomes across nursing homes were inconsistent - QoL improved at some sites but at many it remained stable or declined. Analysis of facilitator notes from the most and least successful clusters indicated that a lack of organizational support, for both the training and subsequent practice of CDC, was potentially the key barrier to effective implementation of training and so improvement in resident QoL. These findings demonstrate that all levels of aged care organizations - on the floor staff, managers and senior staff - need to fully support a CDC model of care to optimize outcomes for residents. Staff require training in CDC as well as long-term culture change within the nursing home so that training can be translated into practice.

This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders' opinions about the impact of COVID-19 on the mental health of aged care residents and staff.A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years,On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios.Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities.This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.

BACKGROUND Elevated psychological distress has demonstrated impacts on individuals’ health. Reliable and efficient ways to detect distress are key to early intervention. Artificial Intelligence has the potential to detect states of emotional distress in an accurate, efficient and timely manner. OBJECTIVE To automatically classify short segments of speech obtained from callers to national suicide prevention helpline services, according to low versus high psychological distress, using a range of voice biomarkers in combination with machine learning approaches. METHODS One hundred and twenty telephone call recordings were initially converted to 16-bit Pulse Code Modulation format. Short variable length segments of each call were rated on psychological distress using the Distress Thermometer by the responding counsellor and a second team of psychologists blinded to the initial ratings (n=6). Nineteen voice biomarkers were derived from 40ms speech frames within each segment. Candidate biomarkers were reduced using Lasso regression, validated by generalised additive mixed effects regression, accounting for non-linearity, autocorrelation and moderation by sex. Speech frames were then grouped using k-means clustering based on the selected biomarkers. Finally, component-wise gradient boosting was used to classify each speech frame according to low versus high psychological distress. Classification accuracy was confirmed via leave one out cross validation ensuring that speech segments from single callers were not used in both the training and test data. RESULTS Using twelve voice biomarkers, 686 of 747 speech segments were successfully classified, AUCROC = 93.8% (95% CI = 91.47, 94.6) and AUCPR = 94.8 (95% CI = 93.0, 96.5). When experiencing elevations in psychological distress, male speakers spoke with increasing loudness, higher frequencies in the 75th percentile of frequencies, but with poorer clarity of speech. In contrast, when experiencing psychological distress, the frequencies with which female callers spoke decreased in the highest quartile of frequencies, but exhibited increased clarity of speech. CONCLUSIONS The high level of accuracy achieved suggests possibilities for real-time detection of psychological distress in helpline settings and has potential uses in pre-emptive triage. CLINICALTRIAL ANZCTR, ACTRN12622000486729, https://www.anzctr.org.au/ACTRN12622000486729.aspx

Perinatal Obsessive-Compulsive Disorder (pOCD) refers to the onset/exacerbation of Obsessive-Compulsive Disorder (OCD) during the perinatal period. This disorder has been studied in mothers, with limited research conducted on fathers. The aim of the current study was to conduct the first systematic review of research investigating the experience of pOCD in fathers. A systematic review was conducted via electronic searches of Scopus, ProQuest, APA PsychNet, PubMed, and EBSCOhost. There were 523 articles identified and screened for eligibility, resulting in six eligible studies included in the final review. All studies reported the presence of subclinical obsessive-compulsive symptoms in fathers during the perinatal period, with the prevalence comparable to mothers. Compared to mothers, however, fathers were found to report less intrusion-related distress. Two studies reported a correlation between dysfunctional beliefs, negative appraisal of intrusions, and pOCD symptoms. Common categories of obsessive thoughts and compulsions experienced by fathers were also identified. Fathers appear susceptible to pOCD, which is consistent with the Cognitive-Behavioral Theory of OCD. Future research is recommended, therefore, to investigate clinical prevalence and severity of pOCD in fathers, particularly relative to mothers, and further investigate the role of dysfunctional beliefs in the development of pOCD.

Purpose The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. Method Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. Results Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. Conclusions Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. Practitioner points Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.

Objective: To investigate and compare patterns of temporal self-appraisal in anxiety and depression. Specifically, whether these parallel the self-enhancing perceptions of a continuous upward traje...

BACKGROUND Elevated psychological distress has demonstrated impacts on individuals’ health. Reliable and efficient ways to detect distress are key to early intervention. Artificial Intelligence has the potential to detect states of emotional distress in an accurate, efficient and timely manner. OBJECTIVE To automatically classify short segments of speech obtained from callers to national suicide prevention helpline services, according to low versus high psychological distress, using a range of voice biomarkers in combination with machine learning approaches. METHODS One hundred and sixteen telephone call recordings were initially converted to 16-bit PCM format. Short variable length segments of each call were rated on psychological distress using the Distress Thermometer by the responding counsellor and a second team of psychologists blinded to the initial ratings (n=6). Nineteen voice biomarkers were derived from 40ms speech frames within each segment. Candidate biomarkers were reduced using Lasso regression, validated by generalised additive mixed effects regression, accounting for non-linearity and autocorrelation. Speech frames were then grouped using k-means clustering based on the selected biomarkers. Finally, component-wise gradient boosting was used to classify each speech frame according to low versus high psychological distress. RESULTS Ten voice biomarkers were used to classify 40ms speech frames to a level of validation accuracy of 94.5% (Area under the receiver operating curve). Male speakers spoke with increasing loudness, roughness, breathiness and with lower dominant and third formant frequencies, when experiencing elevations in distress. Female callers experienced an upward shift in tonal pitch, and breathier speaking style with increasing distress. CONCLUSIONS The high level of accuracy achieved suggests real-time detection of psychological distress in helpline settings and has potential uses in pre-emptive triage. CLINICALTRIAL None

BACKGROUND Artificial Intelligence has the potential to innovate current practices used to detect imminent risk of suicide, and to address shortcomings in traditional assessment methods. OBJECTIVE We sought to automatically classify short segments (40ms) of speech according to low versus imminent risk of suicide in a large number (n = 281) of telephone calls made to two telehealth counselling services in Australia. METHODS This retrospective repeated measures cohort design included 281 helpline calls sourced from On The Line, Australia (n=266) and 000 Emergency services, Canberra (n=15). Imminent risk of suicide was coded for when callers affirmed intent, plan and the availability of means; was assessed as such by the responding counsellor, and re-assessed by a team of clinical researchers using the Columbia Suicide Severity Rating scale (C-SSRS = 5/6). Low risk of suicide was coded for in an absence of intent, plan and means and via C-SSRS = 1/2. Pre-processing involved normalisation and pre-emphasis of voice signals, while voice biometrics were extracted using the statistical language r. Candidate predictors were identified using Lasso Regression. The relationship of each candidate biomarker was assessed as a predictor of suicide risk using a Generalized Additive Mixed effects regression Model (GAMM) using splines to account for non-linearity. Finally, a Component-Wise Gradient Boosting model was trained on 60% of the data, then validated and tested on the remaining data (20%/20%). RESULTS Seventy-seven imminent risk calls were compared with 204 low risk calls. 171,968 40ms frames featuring 36 voice biomarkers were extracted from these calls. Candidate biomarkers were reduced to 11 primary markers, with distinct models needed for men and women. Classification accuracies greater than 99.9% were obtained for imminent suicide risk for each of the data partitions using these primary markers. CONCLUSIONS This study demonstrates an objective, efficient and economical assessment of imminent suicide risk in an ecologically valid setting with potential applications to real-time assessment and response. CLINICALTRIAL ACTRN12622000486729

Complex traumatic experiences, such as childhood sexual and physical abuse, occur in approximately 13% of the Australian population and are more common in women. Despite the prevalence of complex trauma and the need for evidence-based services for survivors, no studies have explored treatment-related experiences of women with complex trauma in Australia. The aim of the current study was to identify barriers and facilitators to treatment seeking and engagement amongst women who have experienced complex trauma in Australia. Semi-structured interviews were conducted with 11 women with complex trauma histories who presented to a university outpatient psychology clinic. Content analysis was used to identify common barriers and facilitators to mental health treatment seeking and engagement amongst these women. Participants faced three key barriers when seeking treatment and engaging in mental health services: systemic issues, dissatisfaction with treatment and intrapersonal barriers (e.g. fear of the healthcare system). Appropriate support from supportive, committed health care workers was a facilitator to engagement and access. Findings from this study suggest that the mental health system in Australia may not be meeting the needs of women with complex trauma histories. Increasing access to affordable, trauma-informed care and bolstering providers' knowledge of complex trauma, may enable some of the barriers identified by participants to be overcome.

In this article, we focus on the various recent healthcare reforms in Australia and their implication for cognitive behavioural therapy (CBT). Specifically, we focus on three areas relevant to CBT ...

Poor cognitive flexibility and perfectionism are common features in anorexia nervosa (AN). The current study aimed to investigate cognitive flexibility and clinical perfectionism as potential predictors of AN. Twenty women with a current diagnosis of AN (M age = 28.25, SD = 7.62) and 170 community participants with no lifetime history of an eating disorder (M age = 29.23, SD = 9.88) took part in an online cross-sectional study that included self-report questionnaires of cognitive flexibility and clinical perfectionism. It was found that compared to the community sample, women with AN self-reported significantly poorer cognitive flexibility and significantly greater clinical perfectionism. In a regression model, clinical perfectionism (but not self-reported cognitive flexibility) significantly predicted group membership. The specificity and sensitivity of the model were high. These preliminary findings indicate that clinical perfectionism may represent a key feature of AN and may accurately discriminate between participants with and without AN, though more research is required.

Objective: Anorexia nervosa (AN) is a serious eating disorder associated with several cognitive difficulties including poor cognitive flexibility (i.e. difficulties in effectively adapting to changes in the environment and/or changing task demands). AN research has primarily assessed cognitive flexibility using neurocognitive tests, and little is known about the differences or similarities between self-report and neurocognitive assessments of cognitive flexibility. This study investigated the relationship between self-report and neurocognitive assessments of cognitive flexibility in people with no history of an eating disorder (n = 207) and people with a self-reported lifetime diagnosis of AN (n = 19). Methods: Participants completed self-report and neurocognitive assessments of cognitive flexibility through an online study. Results: No significant correlations were found between self-report and neurocognitive assessments of cognitive flexibility for either group of the sample, suggesting that these assessments may evaluate different aspects of cognitive flexibility. Further, negative mood and self-reported eating disorder symptoms were found to significantly relate to self-reported cognitive flexibility, but were not associated with performance on neurocognitive tests of cognitive flexibility. Conclusions: To provide a comprehensive understanding of perceived and objective cognitive flexibility in AN, future research and clinical assessments should include both self-report and neurocognitive assessments.

The aim of this review was to understand the barriers and facilitators facing GPs and young adults in raising and addressing suicide in medical appointments. A mixed-methods systematic review was conducted of qualitative and quantitative studies. The focus was papers that explored barriers and facilitators experienced by young adults aged 18 to 26, and GPs working in primary care environments. Nine studies met the inclusion criteria. Four studies provided information on young adults’ views, four on GPs, and one considered both GP and young adults’ viewpoints. Nine barrier and seven facilitator themes were identified. Unique to this review was the recognition that young adults want GPs to initiate the conversation about suicide. They see this as a GP’s responsibility. This review further confirmed that GPs lack the confidence and skills to assess suicide risk in young adults. Both findings combined could explain previous results for reduced identification of suicide risk in this cohort. GP training needs considerable focus on addressing skill deficiencies and improving GP confidence to assess suicide risk. However, introducing suicide risk screening in primary care for young adults should be a priority as this will overcome the need for young adults to voluntarily disclose thoughts of suicide.

Over the past decade, digital mental health has been an emerging priority area for mental health practice and research (Hollis et al., 2018), with the spotlight dramatically shifting to this area s...

Impaired cognitive flexibility has been suggested as a risk factor for the development of anorexia nervosa (AN). The current study aimed to 1) investigate cognitive flexibility in people at various levels of risk of AN; and 2) compare people with a history of AN to people at different levels of risk of AN in cognitive flexibility. The sample comprised of 262 community participants (79% female) and 36 participants with a lifetime diagnosis of AN (97.2% female) aged between 18 and 64 years old. Participants completed self-report (the Depression Anxiety Stress Scale short-form version, the Eating Disorders Examination-Questionnaire, the Neuroticism Scale, and the Cognitive Flexibility Inventory) and neurocognitive (the Trail Making Test and the Wisconsin Card Sorting Test) assessments online to evaluate eating disorder symptoms, depression, neuroticism, and cognitive flexibility. Using a cluster analysis, participants were allocated into low-, medium-, and high-risk of AN groups (n = 88, 128, 46, and 36 respectively). Although high-risk participants self-reported significantly poorer cognitive flexibility than the other risk groups, performance on the neurocognitive tasks was similar across groups. Further, participants with lifetime AN reported significantly poorer cognitive flexibility than the low-risk group. People at high-risk of AN may perceive themselves to have poorer cognitive flexibility compared to those at a lower risk of AN. These results have implications for early identification of people at high-risk of AN.

Objectives: The role of cognitions and beliefs in trichotillomania (TTM; hair pulling disorder) has been the subject of only limited investigation. This study aimed to develop and validate the Beliefs in TTM Scale (BiTS). Methods: A pool of 50 items based upon themes identified in previous research was administered online to 841 participants with and without self-reported problematic, non-cosmetic hair pulling behaviours. Results: Exploratory and confirmatory factor analyses conducted in randomly split-halves of the sample supported retention of 14 items comprising three factors: negative self-beliefs, low coping efficacy, and perfectionism. Conclusions: The BiTS demonstrated satisfactory psychometric properties and all three subscales significantly correlated with greater hair pulling severity. Negative self-beliefs predicted hair pulling severity over and above mood symptoms, suggesting the importance of addressing self-construals in psychological treatments for TTM. Validation in a clinician diagnosed sample is required. Practitioner points: Research supports cognitive therapies for treating trichotillomania (hair pulling disorder), although studies investigating the nature and role of cognitions and beliefs in this disorder have been lacking. This study developed and validated a self-report measure of three styles of beliefs most relevant to trichotillomania: negative self-beliefs, low coping efficacy, and perfectionism. Negative self-beliefs predicted the severity of trichotillomania symptoms over and above depression and anxiety, suggesting such cognitions may not necessarily be due to comorbidities. Future research should validate the new measure in a clinician diagnosed sample, and therapies for trichotillomania may be enhanced by targeting shame specifically.

Improving our understanding of how reward and punishment are experienced by those with trichotillomania (TTM) may assist in the advancement of psychological interventions. The purpose of this study...

We aimed to demonstrate how a large collection of publicly accessible Australian Coroner’s Court case files (n=4459) (2009-2019) can be automatically classified for determination of death by suicide, presence of mental health disorder and sex of deceased via Natural Language Processing (NLP) methods - supervised machine learning and unsupervised dictionary-based and string search based approaches. We achieved superior levels of accuracy in the machine learning classification (Gradient Boosting vs. Random Forest baseline) of deaths by suicide of 83.3% (sensitivity = 85.1%, Specificity = 79.1%) and an accuracy of 98.3% for the dictionary-based classification of mental health disorder, as defined by the OCD-10 (sensitivity = 99.0%, specificity = 97.9%). Our machine learning approach automatically classified 24.2% (1078/4459) of the case files as referring to deaths by suicide while 63.7% (2940/4459) where classified as exhibiting a mental health disorder1. We employed a two-stage machine learning approach involving feature engineering, followed by predictive modelling in the second. Feature engineering involved several steps including removal of low value text, parts of speech analysis, term document weighting and topic clustering. Predictive classification involved extensive hyperparameter tuning to yield the most accurate model. We validated our models against a manually pre-coded subsample of case files, and also via binary logistic regression to test the contribution of each classified mental health disorder against determinations of deaths by suicide according to extant literature. This validation step confirmed elevated odds of suicide attributed to diagnoses of Depression, Schizophrenia and Obsessive Compulsive Disorder. Finally, we offer a short case study to demonstrate the efficacy of our approach in investigating a subset of case findings referring to suicides resulting from family violence. We offer a proof of concept model that demonstrates an objective and scalable approach to the analysis of legal texts. The use of NLP methods in analysing Coroner's Court case findings has important implications for the ongoing development of a real-time surveillance of suicide system in Australia.

Perinatal Obsessive-Compulsive Disorder (pOCD) refers to the onset/exacerbation of Obsessive-Compulsive Disorder (OCD) during the perinatal period. This disorder has been studied in mothers, with limited research conducted on fathers. The aim of the current study was to conduct the first systematic review of research investigating the experience of pOCD in fathers. A systematic review was conducted via electronic searches of Scopus, ProQuest, APA PsychNet, PubMed, and EBSCOhost. There were 523 articles identified and screened for eligibility, resulting in six eligible studies included in the final review. All studies reported the presence of subclinical obsessive-compulsive symptoms in fathers during the perinatal period, with the prevalence comparable to mothers. Compared to mothers, however, fathers were found to report less intrusion-related distress. Two studies reported a correlation between dysfunctional beliefs, negative appraisal of intrusions, and pOCD symptoms. Common categories of obsessive thoughts and compulsions experienced by fathers were also identified. Fathers appear susceptible to pOCD, which is consistent with the Cognitive-Behavioral Theory of OCD. Future research is recommended, therefore, to investigate clinical prevalence and severity of pOCD in fathers, particularly relative to mothers, and further investigate the role of dysfunctional beliefs in the development of pOCD.

UNSTRUCTURED Correction to article

Background Web-based interventions are a promising approach to support youth at risk of suicide, and those incorporating peer-to-peer social networking may have the added potential to target interpersonal states of perceived burdensomeness and thwarted belongingness. Owing to feasibility and safety concerns, including fear of contagion, this had not been tested until recently. In 2018, we conducted a pilot evaluation to test the feasibility, safety, and acceptability of a Moderated Online Social Therapy intervention, called Affinity, with a sample of young people with active suicidal ideation. Objective The aim of this study is to report qualitative data collected from study participants regarding their experience of the web-based social network and the consequent safety features. Methods Affinity is a closed website incorporating 3 key components: therapeutic content delivered via comics, peer-to-peer social networking, and moderation by peers and clinicians. Semistructured interviews were conducted with 17 young people who participated in the pilot study after 8 weeks of exposure to the intervention. Interview data from 2 young people who did not use Affinity were excluded from the analysis. The interviews were analyzed using thematic analysis, with the frequency of responses characterized using the consensual qualitative research method. The results are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Results A total of 4 overarching themes were identified: a safe and supportive environment, the importance of mutual experiences, difficulty engaging and connecting, and the pros and cons of banning discussions about suicide. Interestingly, although Affinity was perceived to be safe and free of judgment, concerns about negative evaluation and triggering others were significant barriers to posting on the social network. Participants generally supported the banning of conversations about suicide, although for some this was perceived to reinforce stigma or was associated with frustration and distress. Conclusions The results not only support the safety and potential therapeutic benefit of the social networking aspect of Affinity but also highlight several implementation challenges. There is a need to carefully balance the need for stringent safety and design features while ensuring that the potential for therapeutic benefit is maximized.

The delivery of videoconferencing psychotherapy (VCP) has been found to be an efficacious, acceptable and feasible treatment modality for individual therapy. However, less is known about the use of VCP for couple and family therapy (CFT). The focus of this systematic review was to examine the efficacy, feasibility and acceptability of using VCP as a treatment delivery modality for CFT. A systematic search was conducted, data relating to efficacy, feasibility and acceptability were extracted from included studies. The search returned 7,112 abstracts, with 37 papers (0.005%) included. The methods of the review were pre-registered (PROSPERO; CRD42018106137). VCP for CFT was demonstrated to be feasible and acceptable. A meta-analysis was not conducted; however, results from the included studies indicate that VCP is an efficacious delivery method for CFT. Recommendations for future research and implications regarding clinical practice are made, which may be of interest to practitioners given the COVID-19 pandemic.

Objective Accurate and reliable assessment of clinical competencies in clinical psychology training requires the use of a range of assessment methods. In addition to traditional written assignments, exams, and clinical supervisor ratings, there is a growing recognition that objective and structured performance-based exams are also required. The objective structured clinical examination (OSCE) is a well-established assessment method that involves a series of assessment stations in which students perform structured clinical tasks, mostly with simulated patients (SPs), while being independently rated by examiners. Several clinical psychology programmes in Australia have started conducting OSCE but descriptions of clinical psychology OSCE are lacking. Method In this paper, we describe the OSCE in four universities. Results Challenges, limitations, and practical issues of this form of assessment, in addition to similarities and differences between OSCE are explored. To promote best practice in the assessment of clinical competencies, we offer seven tips to clinical psychology trainers on setting up an OSCE for their programme. Conclusion The OSCE has the potential to improve the reliability, validity and authenticity of competency assessments in clinical psychology programmes. We hope these OSCE descriptions and tips will encourage programmes to introduce the OSCE and spur further research into this form of assessment. Key points (1) The objective structured clinical examination (OSCE) is a well-established assessment method that can be applied to the clinical psychology training context. (2) Four OSCE applied to clinical psychology training programs in Australia are described. (3) Seven tips are offered to promote best practice in the assessment of clinical competencies using OSCE.

The Wisconsin Card Sorting Test (WCST) is a popular neurocognitive task used to assess cognitive flexibility, and aspects of executive functioning more broadly, in research and clinical practice. Despite its widespread use and the development of an updated WCST manual in 1993, confusion remains in the literature about how to score the WCST, and importantly, how to interpret the outcome variables as indicators of cognitive flexibility. This critical review provides an overview of the changes in the WCST, how existing scoring methods of the task differ, the key terminology and how these relate to the assessment of cognitive flexibility, and issues with the use of the WCST across the literature. In particular, this review focuses on the confusion between the terms ‘perseverative responses’ and ‘perseverative errors’ and the inconsistent scoring of these variables. To our knowledge, this critical review is the first of its kind to focus on the inherent issues surrounding the WCST when used as an assessment of cognitive flexibility. We provide recommendations to overcome these and other issues when using the WCST in future research and clinical practice. Refereed/Peer-reviewed

Phase-based approaches are a recommended treatment option for individuals with complex trauma histories;however, this is based on a limited body of empirical evidence. Phase-based approaches often involve two stages of treatment, with one focusing on safety and stabilisation and phase two on trauma memory processing. Historically, the Australian Better Access Scheme offered a government rebate for up to 10 group and 10 individual psychological sessions annually. In response to the coronavirus pandemic, the number of rebated individual sessions has been increased to 20 through June 2022. Combining individual and group session rebates, phase-based approaches that include both treatment modalities represent a feasible and accessible treatment option for complex trauma. Delivering phase one in a group milieu and providing individual treatment during phase two may be cost effective and optimise outcomes by leveraging the benefits of group and individual treatment for complex trauma. This article aims to provide an overview of the psychological impact of complex trauma, to highlight barriers to seeking mental healthcare, and to critically evaluate phase-based approaches for treating complex trauma. We highlight gaps in the research, followed by a discussion regarding the benefits and limitations of using this approach in the Australian mental health care system. Key points What is already known about this topic: (1) Individuals with complex trauma face barriers when seeking psychological treatment in Australia, including the affordability of specialised mental health care. (2) The number of Medicare-rebated sessions provided by the Better Access Scheme to treat mental health problems is at times inadequate, and clients bear the burden of cost for extra treatment. (3) Despite garnering support from trauma experts, phase-based treatments for trauma related disorders have promising but limited empirical support. (1) Individuals with complex trauma face barriers when seeking psychological treatment in Australia, including the affordability of specialised mental health care.(2) The number of Medicare-rebated sessions provided by the Better Access Scheme to treat mental health problems is at times inadequate, and clients bear the burden of cost for extra treatment.(3) Despite garnering support from trauma experts, phase-based treatments for trauma related disorders have promising but limited empirical support. What this topic adds: (1) Updating prior reviews, a rapid review of the literature identified 15 peer-reviewed papers that examined the delivery of a phase-based treatment for individuals with histories of complex trauma, demonstrating the ongoing implementation of this treatment approach. (2) A phase-based treatment approach for complex trauma is a feasible, accessible and cost-effective option under the current Better Access Scheme, which offers rebates for up to 10 individual sessions (increased to 20 in response to the COVID-19 pandemic through June 2022) and 10 group sessions annually. (3) A phase-based approach that combines group and individual therapy may enable clients to benefit from both group and individual interventions and facilitate continuity of care. (1) Updating prior reviews, a rapid review of the literature identified 15 peer-reviewed papers that examined the delivery of a phase-based treatment for individuals with histories of complex trauma, demonstrating the ongoing implementation of this treatment approach.(2) A phase-based treatment approach for complex trauma is a feasible, accessible and cost-effective option under the current Better Access Scheme, which offers rebates for up to 10 individual sessions (increased to 20 in response to the COVID-19 pandemic through June 2022) and 10 group sessions annually.(3) A phase-based approach that combines group and individual therapy may enable clients to benefit from both group and individual interventions and facilitate continuity of care. [ABSTRACT FROM AUTHOR] Copyright of Australian Psychologist is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background There is currently renewed interest in the use of psychedelic therapy in the treatment of psychiatric disorders, including depression. The proposed systematic review will aim to identify, evaluate and summarise the psychological processes of change underlying psychedelic therapy for depression in the current literature and consider the implications these processes may have on the psychotherapy component of treatment. Methods Scopus, PsycINFO, PubMed and Web of Science databases will be searched using relevant terms. Studies will be included if they discuss the use of a classic psychedelic to treat depression symptomology in an adult population and report or propose psychological processes responsible for depression symptom change. Two authors will independently screen articles, complete quality assessment tools and conduct data extraction. Empirical and non-empirical research will be extracted and synthesised separately. A narrative synthesis approach will be used to report psychological processes identified in the literature. Discussion This systematic review will be the first to collate available evidence on the psychological processes associated with psychedelic therapy for depression. The preliminary nature of this research field is expected to result in the review having several limitations, namely heterogeneity between studies and the inclusion of limited empirical research. We intend for this review to present the current state of the literature, identify gaps and generate candidate variables that warrant further investigation. Systematic review PROSPERO CRD42020197202

The 11th edition of the International Classification of Disease has included Complex Post-Traumatic Stress Disorder (cPTSD) as a clinical diagnosis separate to Post-Traumatic Stress Disorder (PTSD). Research has shown that cPTSD differs significantly from PTSD on core symptoms relating to the individual’s sense of self; which has driven research investigating treatment approaches to address these specific features of cPTSD. Evidence for effective treatments for cPTSD delivered within in-person settings has been synthesised, however, authors have noted significant access barriers to such specialised treatments. Digital-based intervention (DBI) approaches may overcome such access barriers and have shown effectiveness in treating non-complex PTSD across several systematic reviews and meta-analyses. The current protocol however, proposes a methodology for conducting the first systematic review of research investigating the use of DBIs for treating cPTSD, as there has not yet been a comprehensive synthesis of this research. The review seeks to understand (1) the treatment approaches employed in DBIs for addressing symptoms of cPTSD, (2) the symptoms of cPTSD that are targeted by DBIs, (3) the evidence for the acceptability and effectiveness of DBIs in treating symptoms of cPTSD, and (4) measures taken to ensure the safe and confidential delivery of DBIs for cPTSD. A systematic search of Scopus, PsychINFO, and EBSCOhost is proposed, using search terms targeting ‘cPTSD’ and ‘DBIs’. Literature will be screened against eligibility criteria by two independent reviewers and included studies will be assessed for quality using the Quality Assessment Tool for Quantitative Studies. Data will be extracted by the same two reviewers, then analysed and synthesised in narrative form by a single reviewer. The findings from the systematic review will provide an understanding of the state of current evidence and inform directions for direct future research aiming to develop effective DBIs for cPTSD.

BACKGROUND Web-based interventions are a promising approach to support youth at risk of suicide, and those incorporating peer-to-peer social networking may have the added potential to target interpersonal states of perceived burdensomeness and thwarted belongingness. Owing to feasibility and safety concerns, including fear of contagion, this had not been tested until recently. In 2018, we conducted a pilot evaluation to test the feasibility, safety, and acceptability of a Moderated Online Social Therapy intervention, called Affinity, with a sample of young people with active suicidal ideation. OBJECTIVE The aim of this study is to report qualitative data collected from study participants regarding their experience of the web-based social network and the consequent safety features. METHODS Affinity is a closed website incorporating 3 key components: therapeutic content delivered via comics, peer-to-peer social networking, and moderation by peers and clinicians. Semistructured interviews were conducted with 17 young people who participated in the pilot study after 8 weeks of exposure to the intervention. Interview data from 2 young people who did not use Affinity were excluded from the analysis. The interviews were analyzed using thematic analysis, with the frequency of responses characterized using the consensual qualitative research method. The results are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. RESULTS A total of 4 overarching themes were identified: a safe and supportive environment, the importance of mutual experiences, difficulty engaging and connecting, and the pros and cons of banning discussions about suicide. Interestingly, although Affinity was perceived to be safe and free of judgment, concerns about negative evaluation and triggering others were significant barriers to posting on the social network. Participants generally supported the banning of conversations about suicide, although for some this was perceived to reinforce stigma or was associated with frustration and distress. CONCLUSIONS The results not only support the safety and potential therapeutic benefit of the social networking aspect of Affinity but also highlight several implementation challenges. There is a need to carefully balance the need for stringent safety and design features while ensuring that the potential for therapeutic benefit is maximized. CLINICALTRIAL

Background People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. Method This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk of suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. Results The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. Conclusion There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them (i.e., those who prefer anonymity). Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area.

Online social networking interventions have potential to support young people who experience suicidal thoughts by specifically addressing interpersonal risk factors for suicide, but may also pose a risk of harm. This uncontrolled, single-group pilot study aimed to evaluate the safety, feasibility, and acceptability of an enhanced online social networking intervention (&ldquo, Affinity&rdquo, ) among a sample of young people who experienced active suicidal ideation, and to explore potential changes in clinical outcomes and the therapeutic targets of the intervention. Twenty young people with current or recent suicidal ideation who were receiving treatment for depression at a tertiary-level mental health service were given access to Affinity for two months. Participants were assessed at baseline and 8-week follow-up, 90 percent reported clinical suicidal ideation at baseline. A priori criteria related to feasibility, safety and acceptability were satisfied. In terms of potential clinical effects, significant and reliable pre-post improvements were found on self-report outcomes including suicidal ideation. This study provides initial world-first evidence to support the use of an online intervention incorporating social networking as an adjunct to treatment for young people who experience suicidal ideation. The effectiveness of Affinity needs to be evaluated in a randomised controlled trial.