Diagnosis,assessment, and comorbidity in psychosocial treatment research

This paper identifies problems in prevailing terminology and conceptual models that may hinder research on treatment. To avoid the multiple meanings of diagnosis,the term assessmentis used in reference to identifying the distinguishing features of individual cases, while taxonomyis used to designate the grouping of cases according to their distinguishing features. Treatment research requires clear specification of the behavioral/emotional problems and competencies targeted for intervention. Artifactual comorbidity can be avoided by specifying treatment targets at several levels, including competencies, specific problems, syndromes, profiles of syndrome scores, and global problem scores. To select subjects for treatment research and to evaluate outcomes, multisource data can be coordinated by using a cross-informant computer program, taxonomic decision tree, and averaging of multisource standard scores. This work was supported by NIMH grant MH40305 and W. T. Grant Foundation grant 92145892.     

Psychosocial safety climate as a precursor to conducive work environments,psychological health problems,and employee engagement

We constructed a model of workplace psychosocial safety climate (PSC) to explain the origins of job demands and resources, worker psychological health, and employee engagement. PSC refers to policies, practices, and procedures for the protection of worker psychological health and safety. Using the job demands–resources framework, we hypothesized that PSC as an upstream organizational resource influenced largely by senior management, would precede the work context (i.e., job demands and resources) and would in turn predict psychological health and work engagement via mediation and moderation pathways. We operationalized PSC at the school level and tested meso‐mediational models using two‐level (longitudinal) hierarchical linear modelling in a sample of Australian education workers (N = 209–288). Data were repeated measures separated by 12 months, nested within 18 schools. PSC predicted change in individual psychological health problems (psychological distress, emotional exhaustion) through its relationship with individual job demands (work pressure and emotional demands). PSC moderated the relationship between emotional demands and emotional exhaustion. PSC predicted change in employee engagement, through its relationship with skill discretion. The results show that the PSC construct is a key upstream component of work stress theory and a logical intervention site for work stress intervention.     

Explanatory,Multilevel Person-Fit Analysis of Response Consistency on the Spielberger State-Trait Anxiety Inventory

Self-report measures are vulnerable to concentration and motivation problems, leading to responses that may be inconsistent with the respondent's latent trait value. We investigated response consistency in a sample (N = 860) of cardiac patients with an implantable cardioverter defibrillator and their partners who completed the Spielberger State-Trait Anxiety Inventory on five measurement occasions. For each occasion and for both the state and trait subscales, we used the l ^p _z person-fit statistic to assess response consistency. We used multilevel analysis to model the between-person and within-person differences in the repeated observations of response consistency using time-dependent (e.g., mood states) and time-invariant explanatory variables (e.g., demographic characteristics). Respondents with lower education, undergoing psychological treatment, and with more post-traumatic stress disorder symptoms tended to respond less consistently. The percentages of explained variance in response consistency were small. Hence, we conclude that the results give insight into the causes of response inconsistency but that the identified explanatory variables are of limited practical value for identifying respondents at risk of producing invalid test results. We discuss explanations for the small percentage of explained variance and suggest alternative methods for studying causes of response inconsistency.     

Masculinity,femininity, academic performance,and health: Further evidence concerning the androgyny controversy1

Spence and Helmreich's (1978) claim that individual differences in four components of achievement motivation (mastery, work, competitiveness, and personal unconcern) are attributable to masculinity and femininity rather than to gender was generally supported, with one exception: Masculinity was associated with competitiveness for males but not for females. Furthermore, competitive women were more likely than noncompetitive women to have mental and physical health problems, but there was no such difference for males. In general, masculinity emerged as a beneficial constellation of traits for both males and females, correlating negatively with achievement conflicts and stress symptoms, and positively with mastery and work. Femininity, on the other hand, appeared to be a detrimental cluster of traits for both sexes, at least in terms of academic performance and health. Implications for the controversial concept of androgyny were discussed, and it was suggested that, in the future, research inspired by an ideal conception of adult behavior confront the ideal directly rather than describe it in terms of the traditional concepts of masculinity and femininity. Any such research effort will have to deal with the pivotal role of competitiveness.     

The Consequences of Emotional Labor: Effects on Work Stress,Job Satisfaction,and Well-Being

Although early research suggested that the performance of emotional labor had deleterious effects on workers, recent empirical investigations have been equivocal. The performance of emotional labor appears to have diverse consequences for workers—both negative and positive. Variation in the consequences of emotional labor may be due to the different forms of emotion management involved. There is also evidence that the effects of emotional labor are specified by other work conditions. The effects of two forms of emotional labor on work stress, job satisfaction, and psychological distress—self-focused and other-focused emotion management—are explored using data from a survey of workers in a large organization. Results indicate that both forms of emotional labor have uniformly negative effects on workers, net of work complexity, control, and demands. Emotional labor increases perceptions of job stress, decreases satisfaction, and increases distress. Self-focused emotion management has the most pervasive and detrimental impacts. There is little evidence of interaction effects of work conditions and emotional labor.     

Minority Stress,Activism, and Health in the Context of Economic Precarity: Results from a National Participatory Action Survey of Lesbian,Gay, Bisexual,Transgender, Queer,and Gender Non‐Conforming Youth

Lesbian, gay, bisexual, transgender, queer, and gender non‐conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14–24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism.     

Necessity (not just novelty) is the mother of invention: using creativity research to improve research in work and organizational psychology

In this essay, we discuss reasons that work and organizational psychology does not live up to its self-declared mission of being an applied science in the service of improving both people’s quality of working life and organizational effectiveness. We use fundamentals of research on creativity and innovation as a lens through which we can view problems and possible solutions to these problems. In particular, we stress that innovation entails not only new, but also useful insights, that innovation requires “rewarding failure”, and that innovation feeds off of team diversity. We provide suggestions for how the definition of theoretical and empirical contributions of research, reward systems, and collaboration practices could be changed to foster innovative research that helps people thrive at work.     

The challenge of counselling and psychotherapy research

Aims: The purpose of this commentary is to argue that the value of counselling and psychotherapy research lies, not only in what it teaches us as therapists, but also in its ability to challenge us and our assumptions. Method: The paper identifies eight beliefs that may be prevalent in sections of the counselling and psychotherapy community, and presents evidence that challenges them. Findings: While many of our beliefs may hold true for some clients some of the time, the research evidence suggests that they are unlikely to be true for all clients all of the time. Discussion: By questioning and challenging therapists' a priori assumptions, research findings can help counsellors and psychotherapists to be less set in their beliefs; and more open to the unique experiences, characteristics and wants of each individual client.     

Group mentoring to foster the responsible conduct of research

This article reports on a method of group mentoring to strengthen responsible research conduct. A key feature of this approach is joint exploration of the issues by trainees and their faculty research supervisors. These interactions not only help participants learn about current ethical norms for research practice, but also draw on the accumulated experience of faculty and staff about practical problems of research conduct, and help to make faculty more articulate about responsible research conduct and so better able to guide their trainees. By working with departments or laboratories as a whole the method facilitates the formulation of specific norms appropriate to particular research situations and to strengthen the group’s ability to support appropriate behavior and deal with new issues as they arise. It also gives students more ways to ask questions about research practice and to benefit from the experience of all members of their department or group as well as their own research supervisors. The method is well tested and has been well received by a wide variety of departments and research groups. It provides the means for a constructive and enjoyable response to the Public Health Service’s (PHS) new Policy on Instruction in the Responsible Conduct of Research (RCR) that requires education in the responsible conduct of research for all those funded by PHS funds, including faculty and staff as well as trainees. An earlier version of this paper was presented at a National Science Foundation sponsored conference on Mentoring and Research Values: Students as Vital Human Resources, Chicago, IL, USA, March 1995.     

A Hierarchical Multiple-Level Approach to the Assessment of Interpersonal Relatedness and Self-Definition: Implications for Research,Clinical Practice,and DSM Planning

Extant research suggests there is considerable overlap between so-called 2-polarities models of personality development; that is, models that propose that personality development evolves through a dialectic synergistic interaction between 2 key developmental tasks across the life span—the development of self-definition on the one hand and of relatedness on the other. These models have attracted considerable research attention and play a central role in DSM planning. This article provides a researcher- and clinician-friendly guide to the assessment of these personality theories. We argue that current theoretical models focus on issues of relatedness and self-definition at different hierarchically organized levels of analysis; that is (a) at the level of broad personality features, (b) at the motivational level (i.e., the motivational processes underlying the development of these dimensions), and (c) at the level of underlying internal working models or cognitive affective schemas, and the specific interpersonal features and problems in which they are expressed. Implications for further research and DSM planning are outlined.     

The effectiveness of workplace counselling: A systematic review

Background: In response to the stresses of the contemporary workplace, the challenges of maintaining satisfactory work-life balance, and the costs to business of employee mental health problems, many organisations have contracted to make counselling services available to their staff. It is essential to evaluate the effectiveness of workplace counselling, in order to maintain standards, and to identify examples of good practice. Objectives: This paper presents a comprehensive, systematic review of the effectiveness of workplace counselling. Findings are analysed in terms of client satisfaction, psychological functioning, the meaning of work, work behaviour, and negative outcomes. Findings: Taken as a whole, the results of research suggest that counselling is generally effective in alleviating psychological problems, has a significant impact on sickness absence, and has a moderate effect on attitudes to work. Discussion: Methodological issues are discussed, and it is recommended that more high-quality research is required in order to reinforce the evidence base for workplace counselling in relation to a number of key questions.     

Hard-to-manage preschool boys: Externalizing behavior,social competence,and family context at two-year followup

Boys, identified as hard to manage in preschool, were followed up 2 years after initial assessment. Mothers, fathers, and teachers continued to rate hard-to-manage boys as having more problems with attention and impulse control, and as more oppositional, than comparison boys who had been problem-free at intake; problem boys also were rated as less socially competent by all three informants. Differences in severity were apparent as a function of initial referral source. Boys identified as showing significant problems by at least two informants (28% of the problem boys) were especially low in social competence and their mothers reported more symptoms of depression and parenting stress. Family adversity, lower IQ, and severity of symptoms at intake discriminated boys with continuing problems from those with less serious difficulties at followup. Control boys with potentially emerging problems were characterized by more family problems than the remaining control boys. Implications for the development of problems in young children are discussed.The research reported in this paper was supported by NIMH grant No. R01 32735. Special appreciation is expressed to the parents, children, and teachers who cooperated in this work. Thanks are due to the many graduate students and research staff who worked on this project, including Clea Angell, Linda Ewing, Clare Flanagan, Patricia Huszar, Andrea Lurier, Cynthia March, Sarah McAuliffe, Teri Meyers, Elizabeth Pierce, and Emily Szumowski.     

Practice‐based research networks: Origins,overview, obstacles,and opportunities

Aims: This article focuses on the historical origins of Practice‐based Research Networks (PbRNs), particularly in the UK, and provides an overview of exemplar networks, together with a consideration of the obstacles and opportunities of such networks. Method: A selective narrative review was carried out relating to the origins of PbRNs together with a selective systematic review using the SCOPUS database to consider landmark articles in this field. Results: A historical account is provided with the origins of PbRNs deriving from pioneer GPs working alone, with their ideals then becoming embedded in family practice. Key articles are presented and also consideration given to the threats to their survival. Conceptual and developmental models of PbRNs are presented that reflect the variety of networks but also common hallmarks. Finally, the opportunities are summarised that PbRNs offer for providing a vehicle for research that is linked more closely to communities of practitioners, people, and patients. Conclusions: PbRNs provide the opportunities for including practitioners in the research effort by being part of a community. Results will have direct relevance to their practice and advances in data analysis provide more valid means of analysing data. But there are also continuing threats due to lack of infrastructure funding and a gap between PbRN activity and trials methodology that needs to be addressed.     

Job Pressures, Organizational Support, and Health Among Norwegian Women Managers

Questionnaire data were collected from 191 professional and managerial women in Norway. Measures included demographic and work characteristics, job pressures (hours worked, level of management, work-family conflict), organizational supports (acceptance, support, training and development, challenging and visible jobs), and health indicators (life satisfaction, psychosomatic complaints, emotional exhaustion). Emotional exhaustion and psychosomatic complaints were combined into a stress index. Results indicated that women who experienced high role conflict and work-family pressures also reported poor health outcomes and little life satisfaction. Organizational initiatives to support and develop women's careers were associated with lower exhaustion and psychosomatic symptomatology and more life satisfaction. While the relationship between women's employment and physical and psychological well-being is not clear-cut, there is perhaps a need for organizations to focus on initiatives that will allow diversity in the choices women make with regard to involvement in careers and family, as well as a need to find ways to support and encourage such diversity. Not only may this have a beneficial effect on women workers' health and energy to use at work, but it may also make way for alternative career paths into top management positions for professional women.     

Interpersonal Problems,Mindfulness, and Therapy Outcome in an Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder

Objective: To better understand the role interpersonal problems play in response to two treatments for generalized anxiety disorder (GAD); an acceptance-based behavior therapy (ABBT) and applied relaxation (AR), and to examine how the development of mindfulness may be related to change in interpersonal problems over treatment and at follow-up. Method: Eighty-one individuals diagnosed with GAD (65.4% female, 80.2% identified as white, average age 32.92) were randomized to receive 16 sessions of either ABBT or AR. GAD severity, interpersonal problems, and mindfulness were measured at pre-treatment, post-treatment, 6-month follow-up, and 12-month follow-up. Results: Mixed effect regression models did not reveal any significant effects of pre-treatment interpersonal problems on GAD severity over treatment. After controlling for post-treatment GAD severity, remaining post-treatment interpersonal problems predicted 6- but not 12-month GAD severity. Participants in both conditions experienced a large decrease in interpersonal problems over treatment. Increases in mindfulness over treatment and through follow-up were associated with decreases in interpersonal problems, even when accounting for reductions in overall GAD severity. Conclusions: Interpersonal problems may be an important target of treatment in GAD, even if pre-treatment interpersonal problems are not predictive of outcome. Developing mindfulness in individuals with GAD may help ameliorate interpersonal difficulties among this population.     

Associations between Stress,Psychosomatic Complaints,and Parental Criticism among Affluent Adolescent Girls

A growing body of research has shown that adolescent girls in the context of affluence face a series of unique pressures that may increase social-emotional problems. Little research, however, has examined associations between perceived stress and psychosomatic complaints among privileged youth. In the present study, we investigated the relationships between stress, psychosomatic complaints, and parental criticism in a sample of preadolescent and adolescent girls (n?=?218) from selective, private schools. Using OLS regression analyses, cross-sectional and longitudinal associations were evident between perceived stress and psychosomatic complaints, with increases in stress associated with increases in psychosomatic problems. Parental criticism was also examined as a predictor of girls’ psychosomatic complaints and stress levels. Results indicated that parental criticism was significantly and positively associated with psychosomatic problems in cross-sectional models and that perceived stress levels mediated this association. Additional analyses demonstrated that the relationship between psychosomatic complaints and stress may be bidirectional. Taken together, results from this exploratory study suggest that girls in the context of affluence may also experience psychosomatic complaints, in addition to social-emotional problems.     

The Experience of Ethical Dilemmas,Burnout, and Stress Among Practicing Counselors

The authors reported findings from a correlational investigation examining the relationship between counselors' (N = 140) experiences with ethical dilemmas and their reported levels of burnout and stress. Using structural equation modeling, the authors identified that a higher rate of encountering ethical dilemmas related to an increased level of counselor burnout and stress among the participants. However, higher rates of reflecting on the ethical dilemmas did not have a relationship with participants' burnout and stress. The authors present implications of these findings for counselors, along with future research directions.     

Nonresponse in Employee Attitude Surveys: A Group-Level Analysis

Purpose

Given the common practice of using employee attitude surveys as a group-level intervention, this study used a group-level approach to examine the relationship between group satisfaction and group nonresponse.

Design/Methodology/Approach

Samples from four large organizations enabled job satisfaction scores to be aggregated to the work group level and correlated with group-level response rates. Additional regression analysis was conducted to control for a number of confounding variables at the group level.

Findings

Aggregate job satisfaction showed significant associations with group-level response rates across each of the samples examined. Work groups with higher aggregate job satisfaction had significantly higher response rates. Regression analyses showed that, in addition to job satisfaction, work group size, heterogeneity in tenure, and heterogeneity in gender composition all had significant effects on response rates.

Implications

Social influence processes may operate at the group level to increase homogeneity of job-relevant attitudes and similarity in survey response behavior. Future research should be designed to investigate the effects of group-level variables on nonresponse.

Originality/Value

The current study adds to the literature by demonstrating that work group variables may play an important role in explaining nonresponse in employee attitude surveys. Because the processes underlying survey response are likely to be different at different levels of analysis, the investigation of nonresponse as a group-level phenomenon creates new opportunities for research and practice.     

Occupational stress,job satisfaction and physical health in teachers

IntroductionChanges within the teaching profession have been blamed for the high levels of stress reported by teachers. In recent decades, Italian schools have been characterised by continuous change, as a result of profound transitions that have affected political, social and economic development.ObjectiveThis paper investigated the relationship between occupational stress, job satisfaction and physical health in Italian teachers. Specifically, our aim is to study the role of job satisfaction as a possible mediation role between work stressors and its effects on teachers’ physical health (physical symptoms). In addition, we were interested in studying the direct effects of work stressors on the hypothetical outcomes (physical symptoms).MethodData were collected via a questionnaire from a sample of 565 teachers working in different upper secondary schools in Italy. The booklet filled by the teachers consisted of 32 items that measure perceived occupational difficulties, job satisfaction and physical symptoms.ResultsThe results showed that workload, perception of work environment, teachers’ perceptions of senior management and attitude towards change are specific perceived occupational difficulties of the Italian teachers involved in our research. In particular, workload and attitude towards change have significant direct effects on physical symptoms, and indirect effects on physical symptoms through job satisfaction. Also, job satisfaction decreases physical symptoms.ConclusionThe results suggest important implications for stress prevention in teachers. In fact, the level of stress and its consequences can be reduced and prevented through an accurate identification of its sources, with a positive effect on individual and organisational health.     

The ADHD Response-Inhibition Deficit as Measured by the Stop Task: Replication with DSM–IV Combined Type, Extension, and Qualification

Although response inhibition has been proposed as a core element of child attention-deficit hyperactivity disorder (ADHD), the literature is heavily reliant on studies using DSM–III–R diagnostic criteria, older methods of measuring response inhibition, samples of boys, and failing to control thoroughly for comorbid problems—both as diagnoses and as subclinical variation. The present study replicated a deficit in response inhibition in the ADHD combined type (DSM–IV, American Psychiatric Association, 1994) using samples matched on age and sex. The study replicated an effect size of approximately d = .6 in boys with ADHD, and observed an even larger effect size for girls, although the Sex × Group interaction was nonsignificant. Children with ADHD also had problems with response output, shown by variable responding. Excluding comorbid conduct disorder, reading disorder, generalized anxiety disorder, obsessive–compulsive disorder, major depression, and posttraumatic stress disorder from the sample did not alter the results. Correlations indicated that response inhibition was associated with both attentional problems and reading level. Covarying for reading problems did not eliminate the ADHD group effect, but the association of response inhibition with reading clearly requires further examination. Overall, the study supported the role of response inhibition in the DSM–IV ADHD combined type, but with key qualifications as to degree of specificity in reference both to comorbid problems and other executive functions.