Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention

Patients’ expectations have shown to be a major psychological predictor of health outcome in cardiac surgery patients. However, it is unclear whether patients’ expectations can be optimized prior to surgery. This study evaluates the development of a brief psychological intervention focusing on the optimization of expectations and its effect on change in patients’ expectations prior to cardiac surgery. Ninety patients scheduled for coronary artery bypass graft were randomly assigned to (1) standard medical care, (2) additional expectation manipulation intervention (EMI), and (3) additional attention control group. Therapists’ fidelity to intervention manuals and patients satisfaction with the intervention were assessed for both active intervention conditions. Patients’ expectations about post-surgical disability, treatment control, personal control, and disease duration were assessed before and after the psychological intervention. Demographical, medical, and psychosocial characteristics and disability were assessed at baseline. Treatment fidelity and patient satisfaction was very high in both intervention conditions. Only patients receiving EMI developed higher personal control expectations and longer (more realistic) expectations of disease duration. The effect of intervention group on patients’ disability expectations and patients’ personal control expectations was moderated by patient’s level of disability. EMI patients with low to moderate disability developed positive expectations whereas patients with high disability did not. This study shows the successful development of a short psychological intervention that was able to modify patients’ expectations, especially in those with low to moderate disability. Given the robust association of expectations and surgery outcome, such an intervention might offer the opportunity to enhance patients’ health following cardiac surgery.     

Social cognitive predictors of Mexican American college students' academic and life satisfaction

In this study, we used Lent's (2004) social cognitive model of well being to examine the academic and life satisfaction of 457 Mexican American college students attending a Hispanic-Serving Institution. Using structural equation modeling, results indicated that the model provided a good fit to the data. Specifically, we found positive relations from positive affect to enculturation, acculturation, college self-efficacy, academic satisfaction, and life satisfaction; from enculturation to college self-efficacy; from acculturation to college self-efficacy and college outcome expectations; from college self-efficacy to college outcome expectations, academic goal progress, academic satisfaction, and life satisfaction; from college outcome expectations to academic satisfaction; from academic goal progress to academic and life satisfaction; and from academic satisfaction to life satisfaction. Findings indicated the model was invariant across gender groups, and overall, 38% and 14% of the variance in academic satisfaction and life satisfaction, respectively, were explained by the predictor variables. Implications for research and practice are discussed.     

Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life.

This study examined the effects of dietary weight loss and exercise on the health-related quality of life (HRQL) of overweight and obese, older adults with knee osteoarthritis. A total of 316 older men and women with documented evidence of knee osteoarthritis were randomly assigned to 1 of 4 18-month interventions: dietary weight loss, exercise, dietary weight loss and exercise, or healthy lifestyle control. Measures included the SF-36 Health Survey and satisfaction with body function and appearance. Results revealed that the combined diet and exercise intervention had the most consistent, positive effect on HRQL compared with the control group; however, findings were restricted to measures of physical health or psychological outcomes that are related to the physical self.     

Eltern und Patienten als Subjekt der Behandlung

Background

There are hardly any alternatives to inpatient treatment for children and adolescents in need of intensive psychiatric treatment. In the randomized study BeZuHG (“behandelt zu Hause gesund werden”, treated at home become healthy), equality of treatments could be shown in the outcome parameters when comparing TAU (inpatient treatment) and the new treatment module BeZuHG (early discharge followed by intensive home treatment enhanced by clinical elements). Patient satisfaction with each treatment module was evaluated at follow-up.

Material and methods

In this study 144 parents and patients of the intervention group (n?=?79) and the control-group (n?=?65) were interviewed after an average of 8 months. Information on expectations, experience with BeZuHG, changes in communication and interaction within the family as well as problem solving strategies (and sustainability of the changes), overall satisfaction and treatment suggestions for modification of the BeZuHG treatment were collected in semistructured telephone interviews.

Results

The following aspects in the BeZuHG treatment were rated as important by parents and patients: support and help with transfer problems, single sessions, a trusting therapeutic relationship as well as treatment setting at home. Enhanced problem solving skills as well as improved family communication were noticed. In the intervention group 70?% would prefer the BeZuHG setting to inpatient care and 46?% in the control group.

Conclusion

The BeZuHG concept is a good and functional alternative to inpatient treatment. Continuity in treatment and therapeutic relationships are essential for successful treatment at home. Positive treatment results within the family as well as the patient remain stable at follow-up after 8 months.     

Preparing for retirement: how self-efficacy and resource threats contribute to retirees’ satisfaction,depression, and losses

The resource-based dynamic perspective has been applied in this study to explore retirees’ satisfaction, depression, and actual loss of resources. A three-wave design with Spanish workers who were in transition to retirement (N = 286) was used with the aim of investigating correlations between pre-retirement variables and post-retirement well-being. Participants were working at Time 1 and Time 2 but at Time 3, they had retired in the past year. Individual attributes (age), access to resources (life satisfaction and depression), situational characteristics (job stress, job tenure, and retirement transition quality), and psychological disposition (general self-efficacy and positive retirement expectations) at the first wave, correlated with the threat of loss at the second wave. Moreover, these predictors explained how people adjust to retirement at the third wave, assessed both directly (actual loss of resources) and indirectly (satisfaction with retirement and depression), via their effects on Time 2 variables. The results revealed that threat of loss had a positive relationship on loss of resources after retirement, and also both on retirement satisfaction and depression after retirement. Hence, this suggested several avenues for intervention targeting expectations and, in turn, increasing retirees’ well-being, which are discussed.     

Regulatory focus and message framing: A test of three accounts

A review of previous literature shows that there are at least three ways in which regulatory focus may be related to message framing. Specifically, persuasion might be enhanced when there is a match between a person’s regulatory focus and (a) the outcome focus of the message (i.e., gain vs. loss anchor); (b) the overall valence of the message (i.e., positive vs. negative valence); and (c) the type of benefit or harm emphasized (i.e., achievement vs. security). In an effort to explicitly compare and contrast these three possibilities, and to determine whether the results depend on the way regulatory focus is measured, we used a 2 (outcome focus) by 2 (overall valence) by 2 (type of benefit or harm emphasized) within-subjects factorial design and three commonly employed measures of regulatory focus to test the three accounts. The findings were most consistent with the hypothesis that the perceived persuasiveness of a message is increased when there is a match between a person’s chronic regulatory focus and the overall valence of the message.     

Positive expectations in the early years of marriage: should couples expect the best or brace for the worst?

The current study examined whether the effects of positive expectations on changes in marital satisfaction over the first 4 years of marriage were moderated by the nature of spouses' interaction behaviors and relationship attributions. Consistent with predictions, when spouses' skills were most positive, positive expectations predicted more stable satisfaction over time whereas less positive expectations predicted steeper declines. Alternatively, when spouses' skills were most negative, positive expectations predicted steeper declines in satisfaction over time whereas less positive expectations predicted more stable satisfaction. Thus, in contrast to the idea that expectations in the early years of marriage exert main effects on satisfaction, the current findings suggest that the effects of expectations interact with the skills partners bring to their relationships.     

Physician and patient communication training in primary care: effects on participation and satisfaction

OBJECTIVE: To assess the effects of a communication skills training program for physicians and patients. DESIGN: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). MAIN OUTCOME MEASURES: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. RESULTS: The following significant (p < .05) effects emerged: physician training improved patients' satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians' counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians' sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians' satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. CONCLUSION: Implications for improving physician-patient relationship outcomes through communication skills training are discussed.     

Appearance-based exercise motivation moderates the relationship between exercise frequency and positive body image

Individuals with a positive body image appreciate their bodies, hold an internal perspective of their bodies, and are satisfied with the functionality of their bodies. Research shows that positive body image is more complex than the absence of body dissatisfaction. Although exercise reduces women's body dissatisfaction, very little research has explored how, or even whether, exercise is associated with positive body image. Therefore, we examined whether exercise frequency was positively related to three aspects of positive body image (body appreciation, internal body orientation, and functional body satisfaction) among 321 college women. Appearance-based exercise motivation (the extent exercise is pursued to influence weight or shape) was hypothesized to moderate these associations. Hierarchical moderated regression analyses showed that exercise frequency was related to higher positive body image, but high levels of appearance-based exercise motivation weakened these relationships. Thus, messages promoting exercise need to de-emphasize weight loss and appearance for positive body image.     

Evidence That a Very Brief Psychological Intervention Boosts Weight Loss in a Weight Loss Program

Reducing morbidity and mortality associated with being overweight is a crucial public health goal. The aim of the present research was to test the efficacy of a very brief psychological intervention (a volitional help sheet) that could be used as an adjunct to standard weight loss programs to support increased weight loss in an overweight sample. Seventy-two overweight participants currently participating in a weight loss program were randomly allocated to either an intervention (volitional help sheet) condition or a control (distracter task) condition. The main outcome measure was weight at 1-month follow-up. Participants in both conditions lost significant amounts of weight, but those in the intervention condition lost significantly more than those in the control condition (d = 0.66). The findings support the efficacy of the volitional help sheet to promote additional weight loss in an overweight sample engaged in a weight loss program. The volitional help sheet therefore represents a very brief, low-cost intervention that could be used to supplement ongoing weight-loss programs.     

Anorexia nervosa: treatment satisfaction

Patient satisfaction plays a central role in treatment alliance and outcome. Investigating patient expectations and experiences of treatment sheds light on its importance. This study examines adolescent anorexia nervosa patients and their parents' satisfaction with family‐based treatment. Patients and parents answered a questionnaire at the eighteen‐month follow‐up focusing on expectations and experiences of treatment, therapists, aims of treatment and accomplishment. The results show that 73 per cent of the patients and 83 per cent of the parents felt that their pre‐treatment expectations had been fulfilled. The majority agreed that individual patient sessions and parental sessions were of great help, while the patients valued family therapy sessions as being less helpful than did parents. In overall terms, parents were more pleased with the therapists than were the patients. These data suggest that family‐based treatment with individual sessions for patients, in parallel with parental sessions combined with family sessions, corresponds well to patients' and parents' treatment expectations.     

Idiographic outcome analyses of the clinical significance of two interventions for patients with musculoskeletal pain

This study adopted a perspective of the individual to define domains of everyday life for the analysis of clinically meaningful change. The purpose was to compare the clinical significance of two interventions for patients with musculoskeletal pain, applying an idiographic outcome measure, The Patient Goal Priority Questionnaire, in combination with the Jacobson and Truax methodology [(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 67 (3), 300-307] for determination of clinical significance. The concurrent validity of the outcome variables behavioral performance, satisfaction with behavioral performance, and fulfilled pre-treatment expectations was also studied. Eighty-two patients, randomized to either individually tailored behavioral medicine treatment (experimental group) or physical exercise therapy (control group) were evaluated at baseline and 3 months post-treatment regarding behavioral treatment goals. The experimental intervention had high impact on participants' performance of their highest ranked everyday life activities, and resulted in larger proportions of clinically significant outcomes compared with controls. The concurrent validity of the outcomes was high for those reporting clinically significant changes, but more generally, there was a moderate agreement across outcome categories. The individual should be the unit for analyses of clinical significance to enhance the ecological validity of the construct. Further development of idiographic outcome measures is necessary, as is the inclusion in pain intervention research.     

Effects of a Strengths Intervention on General and Work-Related Well-Being: The Mediating Role of Positive Affect

In this article, we explore the use of strengths interventions, defined as activities and processes that target the identification, development, and use of individual strengths, as an organizational tool to increase employee well-being. Engaging with one’s strengths is assumed to be a pleasant activity that elicits positive emotions like joy, pride, and gratitude, which, in turn, contribute to feelings of overall well-being and satisfaction. Building on this assumption, we hypothesized that participating in a strengths intervention leads to increases in general (i.e., psychological capital and satisfaction with life), and work-related well-being (i.e., increased work engagement and decreased burnout), and that positive affect mediates these effects. To test these hypotheses, we conducted a field experiment with a sample of N = 116 Dutch working people who were assigned to either an experimental group (participating in a strengths intervention) or a waitlist control group. All participants filled in a pre-intervention, post-intervention, and 1 month follow-up questionnaire. Results indicate that participating in a strengths intervention creates short-term increases in employee positive affect and short- and long-term increases in psychological capital. We did not find evidence for a positive, direct effect of the strengths intervention on satisfaction with life, work engagement, and burnout respectively, but we did find support for indirect effects via the mediator positive affect.     

When 'fit' leads to fit, and when 'fit' leads to fat: how message framing and intrinsic vs. extrinsic exercise outcomes interact in promoting physical activity

A unique aspect of exercise is that people may choose to engage in it to achieve a variety of outcomes, ranging from extrinsic (appearance, health) to intrinsic (satisfaction, enjoyment). We examined how the impact of gain- vs. loss-framed messages depends on the type of outcome emphasised. Drawing from regulatory focus theory (Higgins, E.T. (1997). Beyond pleasure and pain. American Psychologist, 52, 1280-1300; Higgins, E.T. (2000). Making a good decision: Value from fit. American Psychologist, 55, 1217-1230), we predicted that gain-framed messages would 'fit' with intrinsic outcomes and loss-framed messages would 'fit' with extrinsic outcomes, but the effect of such fit on physical activity would depend on the participants' need for cognition (NC). We tested these hypotheses with a sample of 176 sedentary young adults who read an exercise message with randomly assigned frame (gain/loss) and outcome (intrinsic/extrinsic). Participants provided daily reports of exercise over the following week. The predicted interaction between frame, outcome and NC was found (p=0.001) such that a 'fit' message promoted somewhat, but not significantly, greater exercise for those with high NC, but a 'non-fit' message promoted significantly greater exercise for those with low NC. Furthermore, differences in physical activity were partially mediated by attitudes towards exercise. Findings shed light on how the outcomes and motivations associated with physical activity shape people's behavioural responses to framed health communications.     

Social cognitive predictors of academic persistence and performance in engineering: Applicability across gender and race/ethnicity

We examined the utility of social cognitive variables in the longitudinal prediction of academic persistence and success of engineering students. The participants, 908 students enrolled in engineering majors at two state universities, completed measures of academic support, self-efficacy, outcome expectations, interests, satisfaction, positive affect, and intended persistence at the end of each of their first four semesters. In the current study, students' first and second semester responses were used to predict persistence and grade performance in engineering by the end of six semesters. Path analytic findings indicated that second-semester persistence intentions, satisfaction with the major, self-efficacy, and social support each produced direct paths to persistence. Objective ability (mathematics SAT scores), outcome expectations, and interests were linked to persistence indirectly via their relations to other variables in the model. In addition, self-efficacy and objective ability jointly predicted grade performance. Results were stable across gender and racial/ethnic groups. Implications for research and practice on academic adjustment in engineering are considered.     

Improving adherence to fluid restrictions in male hemodialysis patients: a comparison of cognitive and behavioral approaches.

A cognitive intervention and a behavioral intervention were compared to determine their relative effectiveness in reducing interdialytic weight gain (IWG) among eight adult male hemodialysis patients. The behavioral model consisted of positive reinforcement, shaping, and self-monitoring. The cognitive model consisted of a counseling intervention designed to modify health beliefs. Three small-sample experimental studies showed that both interventions produced immediate reductions in IWG. However, the behavioral intervention was superior to the cognitive intervention in producing maintenance of reduced weight gain. Combining the interventions resulted in no improvement over the behavioral intervention alone. Continuation of self-monitoring procedures produced maintenance of improvements up to 2 months posttreatment. Repeated-measures analysis of variance showed changes for only the "barriers" dimension of the health belief model (Hartman & Becker, 1978) (p < .001), and this occurred only following or concurrent with adherence behavior change. Suggestions for treatment and future research are offered.     

Testing a longitudinal social cognitive model of intended persistence with engineering students across gender and race/ethnicity

We examined the temporal relations within Lent et al.'s (2013) integrative SCCT model of academic satisfaction and intended persistence in a sample of 551 engineering undergraduates from a Hispanic serving institution. They completed measures of instrumentality, support, self-efficacy, outcome expectations, interests, academic satisfaction, and intended persistence at two time points approximately 12 months apart. Using longitudinal cross-panel design, the findings supported a model where: (a) instrumentality predicted self-efficacy, (b) self-efficacy was a temporal precursor for both interests and academic satisfaction, (c) support was a temporal precursor for outcome expectations, while also predicting academic satisfaction, (d) academic satisfaction and intended persistence had a reciprocal relation with one another, and (e) relations in the model did not differ by gender or race/ethnicity. Implications for future research and practice are discussed.