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.     

行为贫困陷阱的心理机制与管理对策：基于认知与动机双视角

借鉴行为经济学家开创的应用行为决策于贫困研究的新范式, 选取我国“连片特困地区”的贫困者为研究对象。首先建构“认知和动机双视角的行为贫困陷阱”的立论模型; 然后通过“贫困所致认知后果影响后继决策行为的心理机制和神经机制”, 以及“贫困所致认知和动机后果共同影响后继决策行为的作用机制”来探索贫困所致心理后果与后继决策行为间的因果效应; 最后进行“贫困所致认知功能改变影响后继决策行为的随机控制实验”和“贫困所致自我认同改变影响后继决策行为的现场干预研究”, 旨在通过“扶志和扶智”达到“授人以渔”, 并从中提炼出可供扶贫政策参考的管理对策。     

Behavioral Intentions: Which Ones Predict Fertility Behavior in Married Couples?1

The published literature on the relationship between behavioral intentions and fertility behavior exhibits four major problems: inconsistent and confusing use of theoretical constructs, limited use of different types of intentions, use of nonbehavioral outcomes, and failure to explore adequately the couple aspects of the intentions/behavior relationship. The study reported here addresses these problems by using a theoretical framework that characterizes the psychological/behavioral sequence leading to a planned conception, three different types of fertility intentions, a behavioral outcome variable, and data from 196 married couples with no children and 185 married couples with one child. Data analysis results in a simultaneous equation, constrained regression model which indicates that child-timing intentions are the most important predictors of proceptive behavior over a 3-1/2 year period and that childbearing intentions are next in importance; that behavioral intentions are the final common pathway through which fertility motivations, attitudes, beliefs, and desires affect behavior; that the use of proceptive behavior as an outcome variable improves the explanatory power of our models; and that the interaction of couple intentions do not demonstrate greater husband or wife influence over couple proceptive behavior but do demonstrate that disagreement has a delaying effect on the onset of that behavior.     

Actions Can Speak as Loud as Words: Measuring Behavior in Psychological Science

It has been argued that there is a growing trend in personality and social psychological science concerning the preference of self‐report measures over the use of direct observations of behavior for the outcome variables of interest. Augmenting the use of self‐reports with measures of behavior helps achieve methodological pluralism that allows researchers to triangulate on the phenomenon of interest and have increased confidence in understanding the phenomenon. To facilitate this process, we discuss a sample of social psychological and personality studies published during APA’s ‘Decade of Behavior’ that use straightforward and innovative ways of measuring behavioral outcome variables. Specifically, we identify three different strategies for incorporating behavior in a study: behavioral traces, behavioral observations, and behavioral choice. In each case, we show how measures of behavior complement self‐report measures. By making a conscientious effort to include more behavior measures in our research, we can broaden the appeal of psychological science by enhancing our understanding of the causes and antecedents of human behavior.     

Why inflammation and the activities of the immune system matter for social and personality psychology (and not only for those who study health)

A growing body of research finds that the activities of the immune system—in addition to protecting the body from infection and injury—also influence how we think, feel, and behave. Although research on the relationship between the immune system and psychological and behavioral outcomes has most commonly focused on the experiences of those who are ill or experiencing an acute immune response, we propose that the immune system may also play a key role in influencing such outcomes in those who are healthy. Here, we review theory and research suggesting that inflammation—a key component of the immune response to pathogens and stressors—may play an important modulatory role in shaping emotions, motivation, cognition, and behavior, even among those without symptoms of illness. Moreover, because inflammation occurs in response to a number of everyday social experiences (e.g., loneliness and stress), we propose that it may be an important mediator of many psychological and behavioral outcomes that are of interest to social and personality psychologists. We close by discussing potential opportunities for researchers looking to incorporate psychoneuroimmunology (PNI) into their area of inquiry.     

Creating a strategy for progress: a contextual behavioral science approach

Behavior analysis is a field dedicated to the development and application of behavioral principles to the understanding and modification of the psychological actions of organisms. As such, behavior analysis was committed from the beginning to a comprehensive account of behavior, stretching from animal learning to complex human behavior. Despite that lofty goal, basic behavior analysis is having a generally harder time finding academic support, and applied behavior analysis has narrowed its focus. In the present paper we argue that both of these trends relate to the challenge of human language and cognition, and that developments within clinical behavior analysis and the analysis of derived relational responding are providing a way forward. To take full advantage of these developments, however, we argue that behavior analysts need to articulate their unique approach to theory, to develop more flexible language systems for applied workers, and to expand their methodological flexibility. This approach, which we term contextual behavioral science, is meant as an evolutionary step that will allow behavior analysis to better capture the center of modern psychological concerns in both the basic and applied areas. Clinical behavior analysis is showing a way forward for behavior analysis to regain its vision as a comprehensive approach to behavior.     

基于自我决定理论的工作动机研究脉络及未来走向

对2018年5月为止基于自我决定理论的工作动机研究英文文献的系统检索得到了97篇实证研究样本。基于自我决定理论的核心假设, 运用“环境-基本心理需要-工作动机-结果”的理论模型对工作动机前因和结果的研究脉络进行了仔细地分析和归纳, 结果表明员工基本心理需要满足和自主性工作动机作为中介变量可解释自主性支持的工作环境和员工个体特征对工作行为、态度和心理健康的积极影响。将来的主要研究议题：一是对控制性工作环境具体因素对员工基本心理需要阻滞、控制性动机和去动机以及员工工作行为、态度和心理健康影响的研究; 二是不同动机类型对员工业绩、行为和态度影响的过程以及情境因素的研究; 三是外部奖励(包括薪酬、基于业绩的奖励等)对员工工作动机、基本心理需要、工作业绩和心理健康的影响及边界条件的深入研究。     

Optimism and pessimism in the context of health: bipolar opposites or separate constructs?

One difficulty plaguing research on dispositional optimism and health is whether optimism and pessimism are bipolar opposites or constitute distinct constructs. The present study examined the Life Orientation Test to determine whether the two-factor structure is explained by method bias (due to measurement) or substantive differences. The authors compared three measurement models: bipolar, bivariate, and method artifact. Optimism and pessimism emerged as distinct constructs due to substantive differences. The authors also considered the validity of optimism and pessimism, examining their relations with psychological and physical health outcomes. Optimism and pessimism were more similar in relation to psychological health than to other health-related behavior or physical health outcomes. However, a strongly interpretable pattern for the relation of optimism and pessimism to the health outcomes did not emerge. Further research may benefit from considering optimism and pessimism as bivariate and also should consider the conceptual components and behavioral mechanisms specific to each variable.     

Cultivating a healthy neuro‐immune network: A health psychology approach

The field of psychoneuroimmunology (PNI) examines interactions among psychological and behavioral states, the brain, and the immune system. Research in PNI has elegantly documented effects of stress at multiple levels of the neuro‐immune network, with profound implications for both physical and mental health. In this review, we consider how the neuro‐immune network might be influenced by “positive” psychological and behavioral states, focusing on positive affect, eudaimonic well‐being, physical activity, and sleep. There is compelling evidence that these positive states and behaviors are associated with changes in immune activity in the body, including reductions in peripheral inflammatory processes relevant for physical health. Growing evidence from animal models also suggests effects of positive states on immune cells in the brain and the blood‐brain barrier, which then impact critical aspects of mood, cognition, and behavior. Tremendous advances are being made in our understanding of neuro‐immune dynamics; one of the central goals of this review is to highlight recent preclinical research in this area and consider how we can leverage these findings to investigate and cultivate a healthy neuro‐immune network in humans.     

包容型氛围感知对员工建言的影响：心理安全感与惰性感知的双重路径

基于社会信息加工理论视角,通过对816名员工与其直接上级进行两时间点配对取样,探讨包容型氛围感知对员工建言的影响,以及心理安全感与惰性感知在两者关系中的作用机制。研究结果表明：员工包容型氛围感知对其建言行为起到促进作用,并通过心理安全感与惰性感知间接影响建言行为。研究结果不仅从理论上丰富与拓展了包容型氛围的效应研究,同时对实务界管理员工建言有一定的实践启示。     

Outcomes in a System of Care for Youths with Emotional and Behavioral Disorders: An Examination of Differential Change Across Clinical Profiles

We assessed the utility of an empirically-derived classification system for youths with emotional and behavioral disorders in a system of care with a strong representation of juvenile delinquents. Eighty-seven youths served in a system of care were categorized by variables related to past history, current behavioral functioning, and current psychological functioning into four clinical clusters. We evaluated preliminary clinical outcomes after six months of interagency involvement for youths within each cluster and across the four clusters. Results indicated that youths in different clusters improved significantly in need-specific areas. Trends in our data indicated differential change in clinical outcomes across clusters. We discuss our findings within the context of emerging outcomes of youths involved in comprehensive community-based programs and consider implications for outcome research, treatment of juvenile delinquents, and mental health policy.     

THE ANALYSIS OF BEHAVIOR WHAT'S IN IT FOR US?

When we publish behavioral research, we are not allowed to communicate the thrill, the poetry, or the exhilaration that are outcomes of the discovery process. Yet, these are among our most potent reinforcers. Explicit recognition of the emotional accompaniments to research could help attract students into the experimental analysis of behavior.     

心理神经免疫学研究

心理神经免疫学（Psychoneuroimmunology）是一门探索人类心身健康奥秘的新型边缘学科。它研究神经系统如何将心理因素转换为可以影响健康的生理状态的机制,特别是脑和行为如何影响免疫系统,又如何受到免疫系统的影响的。免疫系统和神经系统之间是否真正存在联系一直有争论,我们实验室围绕高级神经活动对免疫系统的作用开展了研究。工作包括：条件反射性免疫抑制和增强、情绪应激与免疫、心理行为干预与癌症等。这些工作不仅证实了心理调控,比如信号刺激、情绪和意念想象等,确实可以影响免疫系统的功能,而且对有关机制进行了探讨     

Ethnic differences in the effects of spiritual well-being on long-term psychological and behavioral outcomes within a sample of homeless women

The present study examines ethnicity as a moderator variable between spiritual well-being (SWB) and psychological and behavioral outcomes. Participants included in this analysis were 88 African American (46.6%) and 101 non-African American (total N = 189) homeless mothers. Through structured interviews conducted at 3-month intervals over a period of 15 months, data were collected on spiritual well-being, mental health, trauma symptoms, substance use, parenting, and child behavior. Hierarchical linear model and general estimating equation results indicated that ethnicity moderates the relationship between SWB and anxiety, trauma symptoms, child behavior, and parenting outcomes. On average, African Americans reported significantly higher SWB than non-African Americans, indicating the relative importance of spirituality in their lives. These findings support previous research indicating a difference in the role that SWB plays in the lives of African Americans compared to non-African Americans.     

Current issues and new directions in Psychology and Health : Theory,translation, and evidence-based practice

Health psychology has at least two masters; cognitive behavioral theory and clinical and public health practice. We are expected to contribute to theory by creating new models and adding to existent models of human behavior, and to contribute to improvements in health outcomes for the public. In this brief note, we propose that translating concepts from practice into theory to create interventions that meet the standards of evidence-based practice will satisfy both masters. However, the integration will require a re-examination of our current understanding of how to use theory, the process of translation, and the development of pragmatic evidence-based practice.     

The Financial Dimension of Integrated Behavioral/Primary Care

There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.     

Pregnancy complications and neuropsychological outcomes: A review

Pregnancy complications elevate risk of associated adverse medical, socioenvironmental, and behavioral outcomes in children. These are likely to have a substantial impact on neuropsychological functioning and mental health across the child’s lifespan. Thus, an understanding of the complex relationships between pregnancy complications and neuropsychological outcomes is critical for both practitioners and researchers. This review summarizes prevalent pregnancy complications and the associated psychological and neuropsychological findings, highlighting methodological challenges that have restricted investigations of these outcomes and identifying opportune areas for future study.     

The impact of stigma on behavioral health care utilization among active duty service members

This study assessed the relationship between the stigma of seeking psychological help and use of outpatient behavioral health services over a 2-year period among active duty military service members initially referred for neuropsychological evaluation secondary to their histories of mild traumatic brain injury. Although research has examined how stigma predicts proxies for help-seeking (i.e., attitudes towards/intentions to use services), very little research has looked at actual behavior, and studies that do have largely focused on previous use. In this study, we examined the relationship between participants’ stigma and subsequent behavioral health use. Our results indicated that whereas greater self-stigma (i.e., negative self-judgments for seeking psychological help) was associated with attending fewer behavioral health care sessions, public stigma (i.e., perceptions of public attitudes towards people who seek psychological help) was not associated with service use. These findings support the need for addressing the self-stigma associated with seeking behavioral health care.     

Genes, Brains and Gendered Behavior: Rethinking Power and Politics in Response to Condit, Liesen, and Vandermassen

In response to the commentaries by Condit, Liesen, and Vandermassen, I argue that we lack a more nuanced understanding of women’s political behavior (and therefore politics in general) because of the sustained barrier between the social and natural sciences, historical missteps, researcher bias, and perhaps an inclination to ask the wrong questions. By taking a Darwinian feminist approach to exploring gendered political behavior, and with the tools of behavior genetics and cognitive neuroscience, we can better understand the psychological and behavioral repertoires of men and women as well as predict political outcomes.