Evidence-based treatment of stuttering: II. Clinical significance of behavioral stuttering treatments

An evidence-based framework can be described as an empirically-driven, measurement-based, client-sensitive approach for selecting treatments. It is believed that using such a framework is more likely to result in a clinically significant outcome. For this paper, a clinically significant outcome was defined as a meaningful treatment change. It was suggested that there are at least three groups for whom a treatment's outcome is meaningful. These groups include clinicians/clinical researchers, the clients, and relevant others who have some interest in the outcome (e.g., parents of a child who stutters). The meaning and measurement of clinical significance was discussed for each of these three groups, based on research from the behavioral stuttering treatment literature. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1) broadly define a clinically significant outcome and identify some of the groups who are interested in such an outcome and (2) describe how clinical significance has been evaluated in stuttering treatment within an evidence-based framework.     

Treatment of Insomnia within an Interdisciplinary Pain Rehabilitation Program: A Randomized Trial

Background/ObjectivePrior research indicates interdisciplinary pain rehabilitation program (IPRP) usual care (UC) does not sufficiently address sleep problems among individuals with comorbid chronic pain and clinical levels of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based insomnia intervention. The current study investigates the translation of CBT-I into an IPRP.MethodIn this single-site, prospective, randomized controlled pilot study, insomnia and pain-related outcomes were examined for adults participating in a 10-week IPRP (N = 79) who were allocated to a 4-session group-based CBT-I (IPRP+CBT-I) or usual care (IPRP-UC) condition.ResultsPatients in the IPRP+CBT-I group showed improvements in insomnia symptoms at the end compared to the beginning of the CBT-I group; however, there were no IPRP outcome differences relative to the IPRP-UC condition. Both groups reported statistically significant reductions in insomnia, pain severity, pain-related life interference, and depressed mood. Fewer than one-third of participants reported clinically meaningful reductions in insomnia symptoms following IPRP participation.ConclusionsFurther efforts are needed to address sleep problems in pain rehabilitation settings.     

Inhibition Tasks Are Not Associated with a Variety of Behaviours in College Students

Executive functions are (EF) top-down control processes involved in regulating thoughts, ignoring distractions, and inhibiting impulses. It is widely believed that these processes are critical to self-control and, therefore, that performance on behavioural task measures of EF should be associated with individual differences in everyday life outcomes. The purpose of the present study was to test this assumption, focusing on the core executive function facet of inhibition. A sample of 463 undergraduates completed five laboratory inhibition tasks, along with three self-report measures of self-control and 28 self-report measures of life outcomes. Results showed that although most of the life outcome measures were associated with self-reported self-control, only one of the outcomes was associated with inhibition task performance at the latent-variable level, and this association was in the unexpected direction. Furthermore, few associations were found at the individual task level. These findings challenge the criterion validity of lab-based inhibition tasks. More generally, when considered alongside the known lack of convergent validity between inhibition tasks and self-report measures of self-control, the findings cast doubt on the task's construct validity as measures of self-control processes. Potential methodological and theoretical reasons for the poor performance of laboratory-based inhibition tasks are discussed. © 2020 European Association of Personality Psychology     

Clinical Validity of Prototype Personality Disorder Ratings in Adolescents

A growing body of research shows that personality pathology in adolescents is clinically distinctive and frequently stable into adulthood. A reliable and useful method for rating personality pathology in adolescent patients has the potential to enhance conceptualization, dissemination, and treatment effectiveness. The aim of this study is to examine the clinical validity of a prototype matching approach (derived from the Shedler Westen Assessment Procedure–Adolescent Version) for quantifying personality pathology in an adolescent inpatient sample. Sixty-six adolescent inpatients and their parents or legal guardians completed forms of the Child Behavior Checklist (CBCL) assessing emotional and behavioral problems. Clinical criterion variables including suicide history, substance use, and fights with peers were also assessed. Patients’ individual and group therapists on the inpatient unit completed personality prototype ratings. Prototype diagnoses demonstrated substantial reliability (median intraclass correlation coefficient =.75) across independent ratings from individual and group therapists. Personality prototype ratings correlated with the CBCL scales and clinical criterion variables in anticipated and meaningful ways. As seen in prior research with adult samples, prototype personality ratings show clinical validity across independent clinician raters previously unfamiliar with the approach, and they are meaningfully related to clinical symptoms, behavioral problems, and adaptive functioning.     

Clinical significance methods: a comparison of statistical techniques

Clinically significant change refers to meaningful change in individual patient functioning during psychotherapy. Following the operational definition of clinically significant change offered by Jacobson, Follette, and Revenstorf (1984), several alternatives have been proposed because they were thought to be either more accurate or more sensitive to detecting meaningful change. In this study, we compared five methods using a sample of 386 outpatients who underwent treatment in routine clinical practice. Differences were found between methods, suggesting that the statistical method used to calculate clinical significance has an effect on estimates of meaningful change. The Jacobson method (Jacobson & Truax, 1991) provided a moderate estimate of treatment effects and was recommended for use in outcome studies and research on clinically significant change, but future research is needed to validate this statistical method.     

Behavior as the central outcome in health care

A predominant justification for health psychology and behavioral medicine is that behavior or environmental conditions affect a biological process. Thus, many investigators focus attention on the effects of behavior on cell pathology and blood chemistry. This article argues that behavioral outcomes are the most important consequences in studies of health care and medicine. These outcomes include longevity, health-related quality of life, and symptomatic complaints. Traditional measures in biomedical science often have limited reliability and validity. Their validity is demonstrated only through relationships with longevity, role performance, behavioral functioning, and symptomatic experience, and these correlations are often modest. A model is proposed to guide future investigations. Biological, environmental, and psychological variables are included in the model as predictors or mediators of behavioral health outcomes. Recognizing that health outcomes are behavioral directs intervention toward whatever method produces the most health benefit at the lowest cost.     

Validation of a Behavioral Approach for Measuring Saccades in Parkinson's Disease

Speed and control of saccades are related to disease progression and cognitive functioning in Parkinson's disease (PD). Traditional eye-tracking complexities encumber application for individual evaluations and clinical trials. The authors examined psychometric properties of standalone tasks for reflexive prosaccade latency, volitional saccade initiation, and saccade inhibition (antisaccade) in a heterogeneous sample of 65 PD patients. Demographics had minimal impact on task performance. Thirty-day test–retest reliability estimates for behavioral tasks were acceptable and similar to traditional eye tracking. Behavioral tasks demonstrated concurrent validity with traditional eye-tracking measures; discriminant validity was less clear. Saccade initiation and inhibition discriminated PD patients with cognitive impairment. The present findings support further development and use of the behavioral tasks for assessing latency and control of saccades in PD.     

Psychometric Validation of the Preschool Outcome Questionnaire: A Preschool Treatment Outcome Instrument

Developing normed treatment outcome measures is important to research addressing treatment effectiveness and to improved clinical care. The Preschool Outcome Questionnaire (POQ) is a new measure designed for use with preschool children aged two to six. Designed in collaboration with parents and clinicians, the POQ is brief, easy to administer, score and interpret. This study reports on the instrument’s psychometric evaluation, contains preliminary normative data, and provides a clinical cut-off and a reliable change index to facilitate clinical use of the instrument. Results show that the POQ has acceptable test–retest and internal reliability, concurrent validity and criterion validity. Importantly, results also show that the instrument is sensitive to clinically relevant change. Clinical implications are discussed as well as suggestions for further research.     

Distraction for Pediatric Immunization Pain: A Critical Review

The paper provides a critical review of distraction for pediatric immunizations in order to determine clinical practicality and efficacy of this commonly employed intervention. The MEDLINE and PsycINFO databases were searched to identify papers that included an evaluation of a distraction intervention as a method of pediatric immunization pain management. Fifteen papers were included in this review. Effect sizes were calculated to estimate the clinical significance of findings. In order to examine possible differences in effect sizes related to distraction characteristics, chi square analyses were conducted. Results indicate that distraction is clinically effective in the reduction of pain during pediatric immunizations. Support is found for behavioral and cognitive explanations of distraction mechanisms. Further, various distraction stimulus characteristics were found to be associated with the clinical significance of findings. This article is based on the preliminary examination paper of the first author under the direction of the second, at West Virginia University.     

Anchoring the Panic Disorder Severity Scale

The Panic Disorder Severity Scale (PDSS) is a clinician-administered measure of panic disorder symptom severity widely used in clinical research. This investigation sought to provide clinically meaningful anchor points for the PDSS both in terms of clinical severity as measured by the Clinical Global Impression-Severity Scale (CGI-S) and to extend its clinical meaningfulness by examining its association with quality of life. A total of 63 individuals with a primary diagnosis of panic disorder were assessed on completion of a 6- or 8-week psychotherapy or pharmacotherapy trial for the treatment of panic disorder. As expected, the PDSS was correlated with both the CGI-S and quality of life. These results provide further support for the validity and clinical utility of the PDSS and provide simple anchors to help guide the potential use of the PDSS scale to measure treatment progress in clinical practice.     

Predictive and treatment validity of life satisfaction and the quality of life inventory

The clinical and positive psychology usefulness of quality of life, well-being, and life satisfaction assessments depends on their ability to predict important outcomes and to detect intervention-related change. These issues were explored in the context of a program of instrument validation for the Quality of Life Inventory (QOLI) involving 3,927 clients from various clinical settings. Clinical norms were also generated that supplement existing nationwide norms. The predictive validity of the QOLI and life satisfaction in a university counseling center was supported in terms of its ability to predict academic retention both by itself and in conjunction with cumulative grade point average 1 to 3 years in advance. The QOLI was also found to be sensitive to treatment-related change in two naturalistic clinical settings and samples. The interpretation and intervention utility of measures of quality of life, well-being, and life satisfaction are discussed with respect to clinical and positive psychology research.     

Pediatric Feeding Disorders: A Quantitative Synthesis of Treatment Outcomes

A systematic review of the literature regarding treatment of pediatric feeding disorders was conducted. Articles in peer-reviewed scientific journals (1970–2010) evaluating treatment of severe food refusal or selectivity were identified. Studies demonstrating strict experimental control were selected and analyzed. Forty-eight single-case research studies reporting outcomes for 96 participants were included in the review. Most children presented with complex medical and developmental concerns and were treated at multidisciplinary feeding disorders programs. All studies involved behavioral intervention; no well-controlled studies evaluating feeding interventions by other theoretical perspectives or clinical disciplines met inclusion criteria. Results indicated that behavioral intervention was associated with significant improvements in feeding behavior. Clinical and research implications are discussed, including movement toward the identification of key behavioral antecedents and consequences that promote appropriate mealtime performance, as well as the need to better document outcomes beyond behavioral improvements, such as changes in anthropometric parameters, generalization of treatment gains to caregivers, and improvements in nutritional status.     

Cumulative neurological factors associated with long-term outcomes in adult survivors of childhood brain tumors

Prior research has demonstrated the reliability and validity of the Neurological Predictor Scale (NPS) in relation to childhood brain tumor survivor outcomes; however, its use has not been examined in adult long-term survivors. The current study examines the concurrent validity of the NPS with long-term intellectual and adaptive outcomes in adult survivors of childhood brain tumors relative to individual variables alone. A total of 68 adult survivors of childhood brain tumors (M = 24 years old, SD = 4) almost 16 years post diagnosis (SD = 6) completed intellectual evaluations using the Wechsler Abbreviated Scale of Intelligence (WASI). Survivors’ adaptive functioning skills were assessed via informant structured clinical interviews (SIB-R). NPS scores were computed from data acquired from medical records. The NPS was significantly associated with intellectual (R² = 0.208, p < .05) and adaptive outcomes (R² = 0.30, p < .05) over and above individual risk factors. Approximately 18% of long-term survivors were identified as impaired in intellectual outcomes, and 29% were identified as impaired in adaptive functioning in everyday life skills. The NPS quantifies the cumulative effects of treatment and neurological sequelae experienced by both short- and long-term survivors of childhood brain tumors. It is a useful and easy measure to employ in clinical research that focuses on quantifying the neurological risk factors associated with long-term intellectual and adaptive functioning outcomes in adult survivors of childhood brain tumors.     

Competence in Everyday Activities as a Predictor of Cognitive Risk and Mortality

This study examined the association of a performance-based measure of everyday functioning with clinically meaningful outcomes. Elderly participants in a prospective study of dementia were assessed at two occasions on the Everyday Problems Test for Cognitively Challenged Elderly (EPCCE), a performance-based measure of everyday functioning. Older adults who remained cognitively intact performed approximately 0.66 SD units higher on the EPCCE at both occasions than elders rated as impaired, when covarying on age, education, gender, and cognitive status. Relative to the nonimpaired participants, decline in EPCCE performance over a 2-year interval was significantly greater for impaired participants and those participants who transitioned from nonimpaired to impaired over the course of the study. Increased risk of mortality was associated with lower baseline scores and decline in EPCCE performance even after controlling for demographic variables and performance on the Mini-Mental State Examination. Given the clinical importance of identifying “at risk” elders for impairment, the findings from this study provide initial evidence for the predictive utility of performance-based measures of everyday functioning.     

Competence in everyday activities as a predictor of cognitive risk and mortality

This study examined the association of a performance-based measure of everyday functioning with clinically meaningful outcomes. Elderly participants in a prospective study of dementia were assessed at two occasions on the Everyday Problems Test for Cognitively Challenged Elderly (EPCCE), a performance-based measure of everyday functioning. Older adults who remained cognitively intact performed approximately 0.66 SD units higher on the EPCCE at both occasions than elders rated as impaired, when covarying on age, education, gender, and cognitive status. Relative to the nonimpaired participants, decline in EPCCE performance over a 2-year interval was significantly greater for impaired participants and those participants who transitioned from nonimpaired to impaired over the course of the study. Increased risk of mortality was associated with lower baseline scores and decline in EPCCE performance even after controlling for demographic variables and performance on the Mini-Mental State Examination. Given the clinical importance of identifying "at risk" elders for impairment, the findings from this study provide initial evidence for the predictive utility of performance-based measures of everyday functioning.     

Impaired acquisition of goal-directed action in healthy aging

According to dual-system theories, instrumental learning is supported by dissociable goal-directed and habitual systems. Previous investigations of the dual-system balance in healthy aging have yielded mixed results. To further investigate this issue, we compared performance of young (17–24 years) and older (69–84 years) adults on an instrumental learning task. Following the initial learning phase, the behavioral autonomy of the motivational significance of the instrumental outcome was assessed with an outcome-devaluation test and slips-of-action test. The present study provides evidence for a disrupted dual-system balance in healthy aging, as reflected in reduced outcome-induced conflict during acquisition, as well as in impaired performance during the test stage, during which participants had to flexibly adjust their actions to changes in the current desirability of the behavioral outcome. These findings will be discussed in relation to previous aging studies into habitual and goal-directed control, as well as other cognitive impairments, challenges that older adults may face in everyday life, and to the neurobiological basis of the developmental pattern of goal-directed action across the lifespan.     

Experience Sampling Methods: A Modern Idiographic Approach to Personality Research

Experience sampling methods are essential tools for building a modern idiographic approach to understanding personality. These methods yield multiple snapshots of people's experiences over time in daily life and allow researchers to identify patterns of behavior within a given individual, rather than strictly identify patterns of behavior across individuals, as with standard nomothetic approaches. In this article, we discuss the origin and evolution of idiographic methods in the field of personality and explain how experience sampling methods function as modern day idiographic methods in this field. We then review four primary ways in which experience sampling methods have been used to foster idiographic approaches in personality research. Specifically, we highlight approaches that examine individual differences in temporal and behavioral distributions, situation–behavior contingencies, daily processes, and the structure of daily experience. Following a brief methodology primer, we end by discussing future directions for idiographic experience sampling approaches in personality psychology and beyond.     

The “interbehavioral” approach to treatment

This article introduces and describes the “interbehavioral” approach to clinical intervention as an interdisciplinary system where assessment and treatment encompass physical and psychological effects as continuous interactions. Behavior disorders and their elimination follow a general learning theory model as interpreted by J.R. Kantor. This theory view responses and stimuli as having their own functions that directly affect progress in therapy. Kantor's interbehavioral or “systems” methods obviate the narrow focus of operant (behavioral) psychology by broadening the analysis to include individual history and a better integration of human service disciplines. To this extent, clinical and training applications attend to more of the human operations and overcome such limitations as poor internal validity and problems with generalization of treated behavior to everyday settings. Implications of the interbehavioral system for clinical networks are discussed.     

A Multimethod Approach to Assessing Dependency: The Early Memory Dependency Probe

The construct validity and clinical utility of the early memory probe assessing aspects of dependency was investigated. Clinical patients' responses to the feeding, being fed, or eating probe were compared with Rorschach Oral Dependency (ROD) scale scores (Masling, Rabie, & Blondheim, 1967), as well as theoretically and empirically derived behavioral ratings. Sixty-five psychiatric patients and their therapists participated in the study. Results demonstrated moderate to strong correlations between the early memory scores and the ROD scores, thus demonstrating good concurrent validity. A moderate correlation between the early memory scores and therapists' ratings of key behavioral patterns in therapy support the predictive validity of the early memory probes. The earn memory scores also demonstrated discriminant validity when compared with Rorschach object-relational content scales.