Patient and spouse perceptions of the patient's heart disease and their associations with received and provided social support and undermining

Numerous empirical studies have investigated the relationships between cardiovascular diseases (CVD) and patients’ psychological well-being, with a focus almost exclusively on its dark side. Very little is known on the impact of illness severity on both negative and positive indicators of patients’ well-being, as well as on the psychosocial variables that may mediate this association. Aim of the study was to investigate the impact of illness severity on depression as well as on health satisfaction and life satisfaction of patients undergoing a cardiovascular rehabilitation. It also aimed at testing the mediation of illness perception and self-efficacy beliefs in managing cardiac risk factors. The study involved 172 patients (mean age?=?66.43?years; SD?=?9.99?years; 76.2% men). Illness severity was measured in terms of left ventricular ejection fraction at discharge from the cardiology department, whereas all psychological dimensions were assessed one week later. Results showed significant relationships among illness severity, depression and health satisfaction that were fully mediated by illness perception and self-efficacy beliefs, but not significant relation between disease severity and life satisfaction (χ ²(1)?=?2.30, p?=?n.s.). Overall, findings underline the importance of working on illness perception and self-efficacy beliefs to contrast depression and to improve health and life satisfaction in patients with CVD.     

Relationship of Illness Severity with Health and Life Satisfaction in Patients with Cardiovascular Disease: The Mediating Role of Self-efficacy Beliefs and Illness Perceptions

Guidelines for cardiovascular rehabilitation from different countries underline the importance of psychological factors in the achievement of improved clinical conditions and quality of life in patients with cardiovascular disease (CVD). Nevertheless, little research has been performed to identify the specific factors that greatly affect or foster patients’ quality of life. The aim of the current study was to investigate the contribution of illness perceptions (IP) and self-efficacy beliefs (SE) on the impact exerted by illness severity on health and life satisfaction in patients with CVD undergoing a rehabilitation program. The study had a cross-sectional design and involved 116 patients (mean age = 65.6 years; SD = 10.0 years; 79.3 % men). Illness severity was measured in terms of left ventricular ejection fraction (LVEF) at the discharge from the cardiology department, whereas psychological factors were assessed one week later. The results showed no relationships among LVEF and the two indicators of health and life satisfaction; moreover, these two variables are differently influenced by IP and cardiac risk factors SE (χ²(1) = 0.96, p = n.s.). Findings provide important suggestions for the implementation of interventions aimed at bettering patients’ quality of life, underlying the importance of working on IP and SE to improve levels of health and life satisfaction in patients with CVD.     

Communicating Information About Medication: The Benefits of Making it Personal

Two experiments, using a controlled empirical methodology, investigated the effects of presenting information about medicines using a more personalised style of expression. In both studies, members of the general public were given a hypothetical scenario about visiting the doctor, being diagnosed with a particular illness, and being prescribed a medication. They were also given a written explanation about the medicine and were asked to provide ratings on a number of measures, including satisfaction, perceived risk to health, and intention to comply. In Experiment 1 the explanation focused only on possible side effects of the medicine, whereas in Experiment 2 a fuller explanation was provided, which included information about the illness, prescribed drug, its dosage and contraindications as well as its side effects. In both studies, use of a more personalised style resulted in significantly higher ratings of satisfaction and significantly lower ratings of likelihood of side effects occurring and of perceived risk to health. In Experiment 2 it also led to significantly improved recall for the written information.     

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.     

The Role of Beliefs in Mother-Adolescent Conflict: An Application of the Theory of Planned Behavior

This mixed method study applies components of the theory of planned behavior (Ajzen and Fishbein 1980) to mother-adolescent conflict. We examine if three kinds of beliefs—behavioral, control, and normative—predict patterns of family conflict. Forty mother-adolescent dyads completed an open-ended interview, self-report measures of conflict, and an observational measure of family interaction. Hierarchical multiple regressions revealed that mothers’ and adolescents’ beliefs about the costs and benefits of conflict significantly predicted how they interacted and perceived conflict within dyads. Sex differences and differences between mothers and adolescents were identified. This work contributes to our understanding of the role of both general and specific beliefs in family conflict.     

Perceptual Evidence and Information

Quite recently, Luciano Floridi has put forward the fascinating suggestion that knowledge should be analyzed as special kind of information, in particular as accounted information. As I will try tentatively to show, one important consequence of Floridi’s proposal is that the notion of justification, and of evidence, should play no role in a philosophical understanding of knowledge. In this paper, I shall suggest one potential difficulty with which Floridi’s proposal might be consequently afflicted, yet accept the fundamental suggestion that traditional epistemology should be merrily wedded with the philosophy of information; in particular, I shall plead for the less drastic conclusion, according to which, although knowledge should be taken to entail justification, it is the very notion of evidence—in particular of perceptual evidence—that should be analyzed in information-theoretic terms. By so doing, my principal aim will be to explain away an apparent difficulty—which is preliminary to the preoccupations motivating Floridi’s more ambitious attempt—from which Conee and Feldman’s Evidentialism is apparently afflicted. So, the conclusion that I will try to establish is that the notion of perceptual evidence, once it is appropriately analyzed in information-theoretic terms, should play an important role in our understanding of knowledge.     

Evaluation of a holistic cardiac rehabilitation in the reduction of biopsychosocial risk factors among patients with coronary heart disease

The purpose of this pilot study is to evaluate the effectiveness of the Lifestyle Change Program (LSCP). LSCP was a holistic cardiac rehabilitation (CR) intervention focusing on several psychosocial and biological predictors of coronary heart disease including depression, hostility, low social support, high perceived stress, low spirituality, low life satisfaction, overall health status and cholesterol levels. Utilising a quasi-experimental design, overall health scores of LSCP patients were compared with those of a control group. To assess differences within-and between- groups, two (programme type) × 2 (age) × 2 (gender) × 2 (time) mixed design ANOVAs were used. Within-group relationships for psychosocial assessments and cholesterol levels were analysed using paired-samples t-tests. Results suggest that there were no significant differences between the LSCP group and the control group with regard to overall health status. However, the LSCP participants reported significantly lower levels of depression and perceived stress, as well as significantly higher levels of life satisfaction and spirituality upon programme completion. In addition, lipid panels changed significantly: A significant decrease in total cholesterol, low-density lipoproteins and triglycerides, as well as a significant increase in high-density lipoproteins. These trends suggest that holistic CR may be effective at reducing biopsychosocial risk factors for future cardiac events. Future studies, utilising an experimental design, are necessary to determine whether holistic programmes are more effective than traditional programmes in the reduction of cardiac risk factors.     

Primary school teacher outcomes from online professional development for physical literacy: A randomised controlled trial

IntroductionPrimary (or elementary) school teachers are often relied upon to provide children with opportunities for physical literacy development; however, many of these teachers feel they lack the skills to effectively promote or ‘teach’ physical literacy. We examined the effects of an online physical literacy professional development program—relative to receiving widely-available online resources or continuing with ‘normal’ practice—on primary school teachers’ physical literacy knowledge and application.MethodsA parallel three-arm randomised controlled trial in which 92 primary school teachers were assigned to (a) an online professional development program designed to support teachers’ physical literacy instructional skills (‘intervention’), (b) receive widely-available online physical literacy resources (‘comparison’), or (c) a typical practice ‘control’ condition. Data were collected at baseline and following the four-week intervention period. The primary outcome was teachers’ physical literacy knowledge and application; secondary outcomes included teachers’ self-reported perceptions of confidence, values, and barriers. Between-group differences were assessed using the intention-to-treat principle with analysis of covariance accounting for demographic factors and baseline differences in the focal outcome.ResultsTeachers in the intervention arm scored significantly higher on post-intervention physical literacy knowledge and application than their counterparts in both the control (d = .47, p = .044) and comparison (d = 0.87, p = .007) arms. This pattern of differences was also observed for teachers’ value of physical literacy, autonomy support, and perceived personal barriers.ConclusionTo the best of our knowledge, this is the first adequately powered randomised controlled trial to demonstrate improvements in physical literacy instructional outcomes as a result of primary school teacher participation in targeted online professional development.     

An evaluation of counselling and rehabilitation courses for Chronic Fatigue Syndrome

The aim of the current study was to evaluate the services offered by Action for ME to sufferers of Chronic Fatigue Syndrome using measures developed and validated in previous research. Preliminary studies had suggested that clients attending rehabilitation residential courses were benefiting from the service. A further, more in‐depth evaluation process with a greater number of health‐related outcome measures was warranted. In addition, assessment was widened to include other services offered to sufferers of the illness. Data relating to the usefulness and success of the services (rated by the clients) were also collected. Data from client volunteers were collected at baseline (that is, before intervention) and approximately six months later. Quantitative comparative analyses were conducted using within‐group comparisons to assess any improvements in scores at six‐month follow‐up from baseline. Fifty‐six participants completed wide‐ranging questionnaires assessing illness history, psychopathology, psychosocial factors and health and well‐being. Data relating to improvements in illness status and acceptability of treatment were also collected by means of global outcome measures. Both the counselling and residential groups showed improvements in many areas assessed at follow‐up. Most importantly, improvements were indicated in areas such as fatigue and the levels of disability suffered by patients. In addition, there were significant improvements in ratings of mood, anxiety, depression and physical symptoms. Overall, clients reported satisfaction with the care received and most found the services useful. All of the participants who completed the evaluation stated that they would recommend Action for ME services to fellow sufferers. The outcome of the current study is encouraging. The data presented provides evidence of the high level of support and advice Action for ME offers to sufferers of this illness. Furthermore, measurable improvements in scores relating to illness status were accompanied by improvements in mental health and psychosocial variables in the patient group.     

Is inclusion a valid control for ostracism?

Considerable knowledge about ostracism’s impact comes from research using Cyberball, an online ball-tossing game. In Cyberball, the inclusion condition is the control condition, to which ostracism is compared. The assumption is that Cyberball-inclusion is not affirming and represents an expected level of inclusion. However, without a no-inclusion control condition, it is unclear whether inclusion elevates need satisfaction, whether ostracism depresses need satisfaction, or both. We introduce Cybertree—a control condition designed to provide a similar experience to Cyberball without inclusion. Individuals playing Cybertree did not differ from included individuals in terms of feeling ostracized, level of need satisfaction, and mood. Both Cyberball inclusion and Cybertree differed significantly from ostracized individuals. We conclude that Cyberball inclusion is a reasonable control group for Cyberball ostracism but discuss research questions that may benefit from the use of Cybertree.     

Early childhood educator outcomes from online professional development for physical literacy: A randomised controlled trial

IntroductionEarly childhood is recognised as a critical window of opportunity for physical literacy development, however early childhood educators typically lack the training required to effectively provide appropriate physical literacy opportunities for children. We examined the effects of an online physical literacy professional development program—relative to continuing with ‘standard’ practice—on early childhood educators’ physical literacy knowledge and application.MethodsWe conducted a parallel two-arm randomised controlled trial, in which 88 early childhood educators were randomly assigned to an online professional development program designed to support educators’ physical literacy instructional skills (intervention arm; n = 37), or a ‘standard practice’ control condition (n = 51). Data were collected prior to and after the four-week intervention period. We measured educators’ physical literacy knowledge and application (our primary outcome) through independent coding of open-ended survey responses, and educators’ self-reported perceptions of values, confidence, behaviours, and barriers (secondary outcomes). Between-group differences were assessed through analysis of covariance.ResultsOne intervention arm participant withdrew from the study, resulting in 87 participants included in analysis. Educators in the intervention arm scored significantly higher on post-intervention physical literacy knowledge (d = 0.62) and application (d = 0.33) than those in the control arm. Educators in the intervention arm also scored significantly higher than controls on confidence in teaching physical activity (d = 0.42) and significantly lower than controls on perceived personal barriers to physical activity (d = 0.53). Thirteen participants in the intervention arm (36%) did not begin the online professional development program.ConclusionImprovements in physical literacy instructional outcomes indicate the potential for further investigation into broader implementation of online professional development programs of this nature in the future.     

情绪能力：探讨教师情绪的新视角

摘要：情绪能力（emotional competence,简称EC）是近来教师心理的研究热点,但中国大陆对这方面的研究较为匮乏。本文在梳理国内外的相关文献后发现,教师EC的研究多集中于两方面,一是与教师职业倦怠、工作满意度、教学效能感等教师工作变量的相关关系研究,一是教师EC的干预。虽然目前已有一定的研究成果,但还存在概念不统一、研究较单一以及干预不够科学的问题。     

Measuring the effectiveness of psychoeducation on adherence,depression, anxiety and stress among patients with diagnosis of schizophrenia. a control trial

Despite evidence of the impact of depression and stress on attitudes towards medication in general medical pathology regimens, little is known of the effects of depression and stress on attitudes towards medication in schizophrenia. This study explores the effects of a hope-based psychoeducation on attitudes towards medication, depression, anxiety and stress, and predictors of attitudes towards medication. The participants in the study (n = 29) were randomly allocated to either the psychoeducation group or the control group. Results from the psychoeducation group revealed that attitudes towards medication were significantly improved and anxiety was significantly reduced. Given the small sample, which was recruited from among patients of a day mental health centre, findings should be interpreted tentatively. Being longer in pharmacotherapy, having experienced fewer occurrences of hospitalisation, and being less depressed predicted positivity towards medication. Patients in the control group did not exhibit significant change in any of the studied variables. Findings were interpreted in the light of research on stigma and insight into illness, and add modestly to literature arguing for the importance of patients’ retention of hope, empowerment and sense of control over illness. This study proposed that psychoeducation is an appropriate intervention to address a wide range of factors that compound adherence to medication and patients’ symptoms, such as patients’ interpretations of causal models, their sense of hope and control over the illness, and their insight into illness and self-stigma.

     

Attachment & Child Health (ATTACH) pilot trials: Effect of parental reflective function intervention for families affected by toxic stress

Toxic stressors (e.g., parental violence, depression, low income) place children at risk for insecure attachment. Parental reflective function—parents’ capacity to understand their own and their child's mental states and thus regulate their own feelings and behavior toward their child—may buffer the negative effects of toxic stress on attachment. Our objective was to test the effectiveness of the Attachment and Child Health (ATTACH) intervention, focusing on improving reflective function and children's attachment security, for at-risk mothers and children <36 months of age. Three pilot studies were conducted with women and children from an inner city agency serving vulnerable, low-income families and a family violence shelter. Randomized control trial (n = 20, n = 10 at enrollment) and quasi-experimental (n = 10 at enrollment) methods tested the effect of the ATTACH intervention on the primary outcome of reflective function scores, from transcribed Parent Development Interviews. Our secondary outcome was children's attachment patterns from Ainsworth's Strange Situation Procedure. Despite some attrition, mixed methods analysis of covariance and t tests revealed significant differences in maternal, child, and overall reflective function, with moderate effect sizes. While more children whose mothers received the ATTACH program were securely attached posttreatment, as compared with controls, significant differences were not observed, which may be due to missing observations (n = 5 cases). Understanding the effectiveness of programs like the ATTACH intervention contributes to improved programs and services to promote healthy development of children affected by toxic stress.     

Rational Inference of Beliefs and Desires From Emotional Expressions

We investigated people's ability to infer others’ mental states from their emotional reactions, manipulating whether agents wanted, expected, and caused an outcome. Participants recovered agents’ desires throughout. When the agent observed, but did not cause the outcome, participants’ ability to recover the agent's beliefs depended on the evidence they got (i.e., her reaction only to the actual outcome or to both the expected and actual outcomes; Experiments 1 and 2). When the agent caused the event, participants’ judgments also depended on the probability of the action (Experiments 3 and 4); when actions were improbable given the mental states, people failed to recover the agent's beliefs even when they saw her react to both the anticipated and actual outcomes. A Bayesian model captured human performance throughout (rs ≥ .95), consistent with the proposal that people rationally integrate information about others’ actions and emotional reactions to infer their unobservable mental states.     

Newborn behavioral observations system in rural Pakistan: A feasibility and acceptability study

The Newborn Behavioral Observations (NBO) system is a relationship-based tool that helps parents recognize their infant's competencies and learn their behavioral cues, with the goals of enhancing parental responsiveness and satisfaction in the infant-parent relationship. In our study, a pediatrician integrated the NBO into 44 pediatric health care visits of infants in rural Pakistan villages, under the remote guidance of two U.S.-based child psychiatrists. A clinician then gave the mothers a survey about their experience of the NBO and found that the mothers were highly satisfied, reporting greater appreciation of their infant's strengths, greater understanding of their infant's behavioral cues, stronger attachment to their infant, and greater self-confidence as a mother. In their consideration of these results, the authors explore cultural reasons for the mothers’ responses and generate hypotheses to inform an outcome study of a similar intervention. This was a feasibility and acceptability study and was not randomized, had no control group, and did not use objective measures of outcome.     

Feasibility,Acceptability, and Preliminary Outcomes of the Fortalezas Familiares Intervention for Latino Families Facing Maternal Depression

This pilot study examined the feasibility, acceptability, and preliminary outcomes of a linguistically and culturally adapted intervention for immigrant Latina mothers with depression and their families. Fortalezas Familiares (Family Strengths) is a community‐based, 12‐week, multifamily group intervention that aims to increase communication about family processes leading up to and affected by the mother's depression, build child coping and efficacy, enhance parenting competence and skills, and promote cultural and social assets within the family. In terms of feasibility, of 16 families who enrolled and participated in the intervention, 13 families attended more than 90% of meetings and completed the intervention. Posttests reported positive changes following the intervention, including improved psychological functioning, increased family and marital support, and enhanced family functioning, as reported by mothers and other caregivers. Mothers also reported decreased conduct and hyperactivity problems among their children. Children reported positive changes in their psychological functioning and coping, parenting warmth and acceptance, and overall family functioning. Postintervention focus groups and surveys measuring acceptability revealed families' satisfaction with the intervention and suggested areas of improvement. We discuss similarities and differences in outcomes between the adapted intervention, Fortalezas Familiares, and the original intervention, Keeping Families Strong, and propose future areas of intervention adaptation and development.     

Neural response to evaluating depression predicts perceivers’ mental health treatment recommendations

Nonstigmatized perceivers’ initial evaluations of stigmatized individuals have profound consequences for the well-being of those stigmatized individuals. However, the mechanism by which this occurs remains underexplored. Specifically, what beliefs about the stigmatized condition (stigma-related beliefs) shape how nonstigmatized perceivers evaluate and behave toward stigmatized individuals? We examined these questions with respect to depression-related stigmatization because depression is highly stigmatized and nondepressed individuals’ behavior (e.g., willingness to recommend treatment) directly relates to removing stigma and increasing well-being. In Study 1, we identified common stigma-related beliefs associated with depression (e.g., not a serious illness, controllable, threatening), and found that only perceptions that depression is a serious condition predicted nondepressed perceivers’ willingness to recommend mental health treatment. Moreover, perceivers’ beliefs that depression is a distressing condition mediated the relationship between perceived seriousness and treatment recommendations (Study 1). In Study 2, we used fMRI to disentangle the potential processes connecting distress to nondepressed perceivers’ self-reported treatment intentions. Heightened activity in the dorsomedial prefrontal cortex (dmPFC)—a region widely implicated in evaluating others—and the ventrolateral prefrontal cortex (vlPFC)—a region widely implicated in regulating negative emotions—emerged when nondepressed perceivers evaluated individuals who were ostensibly depressed. Beliefs that depression is a distressing condition mediated the relationship between dmPFC (but not vlPFC) activity and nondepressed individuals’ self-reported treatment recommendations.     

Beyond Mental Competence

Justification for psychiatric paternalism is most easily established where mental illness renders the person mentally incompetent, depriving him of the capacity for rational agency and for autonomy, hence undermining the basis for liberal rights against paternalism. But some philosophers, and no doubt some doctors, have been deeply concerned by the inadequacy of the concept of mental incompetence to encapsulate some apparently appealing cases for psychiatric paternalism. We ought to view mental incompetence as just one subset of a broader justification for psychiatric paternalism. The very basis of liberal limitations on psychiatric paternalism, whether described in terms of rights to autonomy or as respect for differences in values and lifestyles, presupposes a sense of moral persistence, and hence some sufficiently persistent self. Paternalistic intervention is warranted when we are unable to govern our lives in a manner consistent with the goals and values that comprise that ‘self’. One way that can occur is when we lack the mental capacities required for autonomy, such that we are unable to interpret and interact with our environment in order to meaningfully pursue our goals, i.e. mental incompetence. But it can also occur when we are subject to impositions that alter our goals without altering our capacity to pursue them — i.e. when it is our ‘self’ that is impaired rather than our competence.