Response to an abnormal ovarian cancer-screening test result: Test of the social cognitive processing and cognitive social health information processing models

All cancer screening tests produce a proportion of abnormal results requiring follow up. Consequently, the cancer-screening setting is a natural laboratory for examining psychological and behavioural response to a threatening health-related event. This study tested hypotheses derived from the social cognitive processing and cognitive–social health information processing models in trying to understand response to an abnormal ovarian cancer (OC) screening test result. Women (n = 278) receiving an abnormal screening test result a mean of 7 weeks earlier were assessed prior to a repeat screening test intended to clarify their previous abnormal result. Measures of disposition (optimism, informational coping style), social environment (social support and constraint), emotional processing, distress, and benefit finding were obtained. Regression analyses indicated greater distress was associated with greater social constraint and emotional processing and a monitoring coping style in women with a family history of OC. Distress was unrelated to social support. Greater benefit finding was associated with both greater social constraint and support and greater distress. The primacy of social constraint in accounting for both benefit finding and distress was noteworthy and warrants further research on the role of social constraint in adaptation to stressful events.     

Receipt of a False Positive Test Result During Routine Screening for Ovarian Cancer: A Teachable Moment?

The term "teachable moment" (TM) has been used to describe a life transition or event which motivates an individual to change a behavior or presents an opportunity to intervene to prompt behavior change. We examined whether receipt of a false positive ovarian cancer (OC) screening result may represent a TM. 403 women participating in an OC screening program completed questionnaires assessing demographic, clinical, behavioral, and psychosocial information. The TM was operationalized as expressed interest in receiving health-related information. We hypothesized that among women receiving a false positive screening test result, those women who had experienced greater personal perceived risk for OC as well as distress would be more interested in receiving health-related information than women receiving a normal result. Analyses revealed that women receiving a false positive screening result were less interested in receiving health-related information than women receiving a normal screening result. For women receiving a false positive result, expressed interest in receipt of health-related information was only modestly related to distress and related even less to perceptions of OC risk. Our data do not support viewing a false positive OC screening result as a TM. Potential explanations for the current findings as well as recommendations for future research investigating the TM are discussed.     

Treatment of Obsessive Compulsive Disorder in Young Children: An Intervention Model and Case Series

This article presents an intervention model for young children with obsessive-compulsive disorder (OCD). The intervention, designed to reduce compulsive behavior and improve parenting practices, was tested using a multiple baseline design with 7 children (M = 6 years old; 57% female) in which participants were randomly assigned to 1, 2, or 3 weeks of baseline (i.e., no treatment). All children were diagnosed with OCD using a semi-structured diagnostic interview. Baseline and weekly ratings of obsessive-compulsive (OC) symptoms and family accommodation were obtained. In addition, at pre- and post-treatment and 1-month follow-up, independent evaluators and/or parents completed measures assessing the severity and impact of OC symptoms and child and family functioning. Findings revealed that participants had a 33–66% reduction in OC symptoms (as measured by the Children's Yale-Brown Obsessive Compulsive Scale; CYBOCS) at posttreatment and 6 of the 7 children were rated as treatment responders on the Clinical Global Impression-Improvement (CGI-I) Scale. At the 1-month follow-up, participants had a 17–82% reduction in OC symptoms. Treatment was also effective in reducing parental accommodation of child OC behaviors. Overall treatment satisfaction was high and parents found most core treatment ingredients (e.g., psychoeducation, exposure and ritual prevention, contingency management) very helpful. Implications for further developing and testing psychosocial treatments for young children are discussed.     

Guided self-help versus pure self-help for perfectionism: a randomised controlled trial

Perfectionism is known to be a risk factor for the development and maintenance of obsessive-compulsive (OC) and depressive symptoms. The purpose of the present study was to test the effectiveness of a cognitive-behavioural self-help therapy for perfectionism, and to examine the effect of such treatment on OC and depressive symptomatology. The study compares the effectiveness of guided self-help (GSH, n=24) with pure self-help (PSH, n=25) therapy. Both GSH and PSH were found to be effective in reducing perfectionism, and also in reducing OC and depressive symptomatology. Overall, participants in the GSH condition experienced greater symptom improvement than participants in the PSH condition, and treatment gains for both groups were largely maintained at 3-month follow-up. Twenty percent of PSH participants experienced clinically significant increases in depressive symptoms over the treatment and follow-up period (compared to 0% in the GSH condition), suggesting that PSH may be a less suitable strategy than GSH in treating this population. Overall, the findings suggest that self-help for perfectionism is effective in reducing OC and depressive symptomatology in non-clinical individuals, with GSH being superior to PSH.     

Psychological impact of benign breast biopsy: a longitudinal, comparative study.

The impact of benign breast biopsy (BBB) on distress and perceptions of risk for breast cancer (BC) was examined. Interviews were conducted with 100 women shortly after notification of biopsy results and 4 and 8 months post-BBB. Compared with matched healthy comparison (HC) women without BBB, the BBB group evidenced greater BC-specific distress at baseline. BC-specific distress declined after BBB, remaining elevated relative to the HC group at the 8-month follow-up. Dispositional (optimism, informational coping style), demographic (education), clinical (family history of BC), and cognitive (BC risk perception) variables were associated with baseline levels of BC-specific distress or persistence of distress. Results support the monitoring process model (S. M. Miller, 1995) and the cognitive social health information processing model (S. M. Miller, Y. Shoda, & K. Hurley, 1996).     

A cognitive behavioral workshop for subclinical obsessions and compulsions

The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n = 42), individuals assigned to the workshop group (n = 43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms.     

Demographics, Prevalence, and Clinical Features of the Schizo-obsessive Subtype of Schizophrenia

The schizo-obsessive subtype of schizophrenia has been proposed to describe the condition of patients with chronic psychotic disorders and prominent obsessive-compulsive (OC) symptoms. These patients differ from others with schizophrenia not only in their psychopathology, but perhaps also in their prognosis and pharmacotherapeutic response. Potent serotonin reuptake blockers, such as clomipramine, fluvoxamine, and fluoxetine, in conjunction with antipsychotics, can prove helpful in improving these patients' OC symptoms. The current study to access the demographics, prevalence, and clinical features of the schizo-obsessive subtype included established outpatients with a principal diagnosis of schizophrenia or schizoaffective disorder treated at a large urban public hospital. More than 50% of the hospital's psychiatric population is Hispanic. The Modified Maudsley Obsessive Compulsive Inventory (MMOCI) was used to identify prominent compulsive symptoms. Of the 52 patients who fulfilled the specific screening criteria, 17 (33%) also had prominent OC symptoms. Surprisingly, there was a statistical trend (P=0.06) for Hispanic patients to meet our threshold for the schizo-obsessive subtype. The MMOCI proved to be an adequate and efficient self-rated screening tool. The prevalence of the schizo-obsessive subtype, especially among Hispanic patients, highlights the importance for mental health professionals working with this population to identify and appropriately treat this group of patients.     

"When no means no": can reactance augment the theory of planned behavior?

A longitudinal study examined women's clinic attendance for treatment and follow-up after having received an abnormal cervical screening result. Participants (N = 660) completed questionnaire measures of variables specified by the theory of planned behavior and J. Kuhl's (2000) measure of low volitional control--reactance--prior to receiving up to 3 subsequent appointments during the following 15 months. The theory of planned behavior was capable of predicting persistent attendance and discriminated women who kept all of their scheduled appointments from those who dropped out from treatment. Consideration of reactance enhanced prediction of behavior and discriminated between women who delayed appointment keeping and women who ceased attending.     

Cognitive Functioning in Adolescents with Self-Reported ADHD and Depression: Results from a Population-Based Study

This study aims to assess cognitive functioning differences among adolescents with retrospectively self-reported: ADHD and an onset of depression, only ADHD, only depression, and neither ADHD nor depression. Data from the Tracking Adolescents’ Individual Lives Survey (TRAILS) cohort was used in this study. Neuropsychological functioning was assessed in 1549 adolescents, at baseline and follow-up (mean ages 11 and 19 years). The Composite International Diagnostic Interview was used to classify adolescents into 4 groups: ADHD with onset of depression, only ADHD, only depression, and neither ADHD nor depression. Linear mixed effects models were used to analyse group differences in cognitive functioning at baseline and follow-up, and the change in cognitive functioning between these 2 time-points. Results showed a significant main effect of group on response time variability at baseline, working memory maintenance at follow up, and change in response time variability scores between baseline and follow-up. As compared to the healthy and depressed-only groups, adolescents with only ADHD showed longer response time variability at baseline and, which declined between baseline and follow-up. Adolescents with ADHD plus depression showed higher reaction time for working memory maintenance than the depressed only and healthy groups at follow-up. In conclusion, adolescents with self-reported ADHD show poorer cognitive functioning than healthy adolescents and those with only depression. Amongst adolescents with ADHD, specific cognitive domains show poor functioning depending on the presence or absence of comorbid depression. While adolescents with only ADHD have lower reaction time variability, those with comorbid depression have poorer working memory maintenance.     

Positive and negative mood following imaging-guided core needle breast biopsy and receipt of biopsy results

Positive and negative mood are independent psychological responses to stressful events. Negative mood negatively impacts well-being and co-occurring positive mood leads to improved adjustment. Women undergoing core needle breast biopsies (CNB) experience distress during CNB and awaiting results; however, influences of mood are not well known. This longitudinal study examines psychosocial and biopsy- and spirituality-related factors associated with mood in patients day of CNB and one week after receiving results. Ninety women undergoing CNB completed questionnaires on psychosocial factors (chronic stress, social support), biopsy experiences (pain, radiologist communication), and spirituality (peace, meaning, faith) day of CNB. Measures of positive and negative mood were completed day of CNB and one week after receiving results (benign n = 50; abnormal n = 25). Multiple linear regression analyses were conducted. Greater positive mood correlated with greater peace (β = .25, p = .02) day of CNB. Lower negative mood correlated with greater peace (β = ?.29, p = .004) and there was a trend for a relationship with less pain during CNB (β = .19, p = .07). For patients with benign results, day of CNB positive mood predicted positive mood post-results (β = .31, p = .03) and only chronic stress predicted negative mood (β = .33, p = .03). For women with abnormal results, greater meaning day of CNB predicted lower negative mood post-results (β = ?.45, p = .03). Meaning and peace may be important for women undergoing CNB and receiving abnormal results.     

Comparing two theories of health behavior: a prospective study of noncompletion of treatment following cervical cancer screening.

Some women receiving abnormal cervical screening tests do not complete recommended treatment. A prospective study (N = 660) investigated the value of conceptualizing attendance at colposcopy for treatment as either (a) an active problem-solving response to a health threat, motivated by attitudes toward an abnormal result, as implied by self-regulation theory (H. Leventhal, D. Meyer, & D. Nerenz, 1980); or (b) as a behavior motivated by attitudes toward clinic attendance, as implied by the theory of planned behavior (TPB; I. Ajzen, 1985). Responses to questionnaires containing variables specified by these models were used to predict women's subsequent attendance or nonattendance for treatment over the following 15 months. Although the TPB offered superior prediction of intentions and completion of treatment, discriminant function analyses showed that consideration of both models was important in distinguishing between those who attended all their appointments as scheduled, attended after being prompted, or ceased attending. Implications for measurement and theory in health protection are discussed.     

Risk Reduction Behaviors and Provider Communication Following Genetic Counseling and BRCA1 Mutation Testing in an African American Kindred

Little is known about the impact of cancer genetic counseling and testing on health behaviors in racial and ethnic subgroups. This prospective observational study examined use of risk reduction strategies following BRCA1 counseling and testing. Participants were female members of an African American kindred who received genetic education, counseling and testing (n = 40) and completed a 1-year follow-up interview. Mutation carriers were more likely to opt for breast (100%, 7/7) and ovarian (25%; 1 of 4) cancer surveillance than prophylactic surgery. Following genetic counseling, 71% (5/7) of the BRCA1 carriers who opted for surveillance reported having a mammogram within the year following receipt of their genetic test results. Ovarian cancer screening among mutation carriers increased from 0% at baseline to 25% (one of four) at 1 year. Compared to noncarriers (23%, 7/30), carriers (70%, 7/10) were more likely to discuss their BRCA1 test results with their primary health care providers. Surveillance for breast cancer was preferred to prophylactic surgery and chemoprevention as a way to reduce risk for these cancers. Our data indicate that patient-provider communication about BRCA1 test results is suboptimal.     

Alcohol-Induced Amnesia and Personalized Drinking Feedback: Blackouts Predict Intervention Response

Alcohol-induced amnesia (“blackout”) is a reliable predictor of alcohol-related harm. Given its association with other negative consequences, experience of alcohol-induced amnesia may serve as a teachable moment, after which individuals are more likely to respond to intervention. To test this hypothesis, alcohol-induced amnesia was evaluated as a moderator of brief intervention effect on (a) alcohol-related consequences and (b) the proposed intervention mediators, protective behavioral strategies and peak blood alcohol concentration (BAC). Baseline alcohol risk measured using the Alcohol Use Disorders Identification Test (AUDIT) was also evaluated as a moderator to rule out the possibility that amnesia is simply an indicator of more general alcohol risk. College students (N = 198) reporting alcohol use in a typical week completed assessments at baseline and 1-month follow-up as part of a larger intervention trial. Participants were randomized to assessment only (AO; n = 58) or personalized feedback intervention (PFI; n = 140). Hierarchical regression was used to examine direct and indirect intervention effects. A significant group-by-amnesia interaction revealed that only PFI participants who had experienced alcohol-induced amnesia in the past month reported decreases in alcohol consequences at 1-month follow-up. The PFI reduced alcohol-related consequences indirectly through changes in peak BAC, but only among those who had experienced amnesia at baseline. In contrast, baseline alcohol risk (AUDIT) did not moderate intervention effects, and use of protective behavioral strategies did not statistically mediate intervention effects. Findings suggest that loss of memory for drinking events is a unique determinant of young adult response to brief alcohol intervention. Normative feedback interventions may be particularly effective for individuals who have experienced alcohol-induced amnesia in the past 30 days.     

Declining medical decision-making capacity in mild AD: a two-year longitudinal study

This is a report of a two-year longitudinal study comparing healthy older adult subjects (n = 15) and mild Alzheimer's disease (AD) patients (n = 20) using an objective performance measure of medical decision-making capacity (MDC). Capacity to consent to medical treatment was measured using the Capacity to Consent to Treatment Instrument (CCTI). The CCTI is a psychometric measure that tests MDC using a series of four core capacity standards: S1 (evidencing/communicating choice), S3 (appreciating consequences), S4 (providing rational reasons), and S5 (understanding treatment situation), and one experimental standard [S2] (making the reasonable treatment choice). For each standard, mild AD patients were assigned one of three capacity outcomes (capable, marginally capable, or incapable) based on cut-off scores derived from control group performance.At baseline, mild AD patients performed equivalently with controls on simple standards of evidencing a choice (S1) and making the reasonable choice ([S2]), but significantly below controls on complex standards of appreciation, reasoning, and understanding (S3, S4, and S5) (p < 0.02). Control performance was stable over time on all capacity standards. At one-year follow-up, the mild AD group did not show significant decline from baseline on any capacity standard. However, at two-year follow-up the mild AD group showed significant declines from baseline on the three complex standards (S3, S4, and S5) (p < 0.02), and a trend on one of the simple standards (S1). Over the two-year period, the proportion of marginally capable and incapable outcomes in the AD group increased substantially for four of the five standards (S1, S3, S4, and S5). Performance on [S2] remained stable over time in the AD group.We conclude that mild AD patients have impaired MDC at baseline, and demonstrate significant additional decline on complex consent abilities of appreciation, reasoning, and understanding over a two-year period. AD patients also show emerging impairment on the simple consent ability of evidencing choice at two-year follow-up. Capacity outcome data reflect similar declines over time for these four consent standards. The findings suggest the value of early assessment and regular monitoring at two-year intervals of MDC in patients with mild AD.     

Effects of Counseling and Ethnic Identity on Perceived Risk and Cancer Worry in African American Women

Improving breast screening behaviors in African American women is an important public health goal. To increase participation in screening, it is necessary to identify factors that contribute to reduced screening, including perceived risk and cancer worry. This paper presents predictors of changes perceived in risk and worry among African American women of differing ethnic identities as they undergo breast cancer risk counseling. Participants (n = 113) were recruited from community sources to a study of counseling for breast cancer risk. They completed a baseline assessment, randomly received breast cancer risk counseling or served as a control group, and completed a follow-up assessment. Counseling produced significant differences in perceived risk and cancer worry. Predictors of risk and worry changes, as a result of counseling, included income and ethnic identity. These data can guide better services for African American women and research into the complexity of the effects of ethnic identity on health.     

Obsessive compulsive features predict cautious decision strategies

Introduction: Obsessive compulsive disorder (OCD) is occasionally characterized by decision-making deficits. Compared to the isolated analysis of the choice and response times, characterizing decision outputs at the level of latent processes can be a more powerful approach in revealing differences, even in subclinical cases. We hypothesized that participants with higher obsessive compulsive (OC) features would set their decision thresholds higher and thus make more cautious decisions. Method: We used a perceptual two-alternative forced-choice (2AFC) task (dot motion discrimination) to test this hypothesis in a non-clinical sample (N?=?74). We fitted the data with the diffusion model and evaluated the optimality of decision outputs. We also conducted exploratory analyses to reveal which subscales best predicted the differences at the level of latent decision processes. Results: Higher OC total scores in Maudsley and Padua scales significantly predicted higher threshold settings (cautiousness). The follow-up exploratory analyses with subscale scores showed that checking and rumination tendencies predicted higher threshold settings whereas washing tendency predicted faster non-decision times. Conclusions: Our primary results showed that participants with higher degrees of OC features exhibit more cautious decision making. Our exploratory analyses also revealed distinctions based on different types of OC features in both controlled (cautiousness in decision making) and automatic (faster non-decision times) elements of the decision process.     

The influence of preferred coping style and cognitive strategy on laboratory-induced pain.

OBJECTIVE: To evaluate the effects of matching an individual's coping style (low, mixed, or high monitoring) to an appropriate cognitive strategy (distraction or sensation monitoring) to improve pain management. DESIGN: This study used a split-plot factorial design in a laboratory setting. MAIN OUTCOME MEASURES: Main outcomes were pain threshold, pain tolerance, pain intensity, pain affect, and anxiety. RESULTS: The results of the 2 x 3 x 3 (Experimental Condition x Coping Style x Trial) analysis of variance (ANOVA) interaction were significant for pain threshold scores, F(4, 178) = 2.95, p < .01. Low monitors in the matched distraction trial had higher pain threshold scores than during baseline, t(15) = -2.68, p = .017, and the mismatched sensation monitoring trial, t(15) = 2.80, p = .014. High monitors' pain threshold scores were higher than baseline only during the matched sensation monitoring trial, t(27) = -2.75, p = .010. The results of the 2 x 3 x 3 ANOVA interaction were not significant for pain tolerance scores; however, when the mixed monitors were excluded, the 3-way interaction was significant, F(2, 124) = 3.48, p < .05. The results were nonsignificant for pain intensity, pain affect, and anxiety. CONCLUSION: Results demonstrate that matching coping style to the appropriate cognitive strategy is important for improving pain threshold and pain tolerance; however, matching did not reduce pain intensity, pain affect, or anxiety. Future studies should explore the explanation for differential responses of high and low monitors and should test these hypotheses in a clinical setting.     

Danger ideation reduction therapy for obsessive-compulsive checking: preliminary findings

Danger Ideation Reduction Therapy (DIRT) is a cognitive treatment package developed in the mid-1990s to treat obsessive-compulsive (OC) washing. DIRT is solely directed at decreasing threat expectancies and does not involve direct or indirect exposure. The effectiveness of the DIRT package for OC washers has been examined, and to date a number of publications, including two randomised controlled trials, support its efficacy. Recently, the DIRT package was modified to treat people with the OC checking subtype. In the current study, three adult OC checkers received DIRT in 12 to 14 individual 1-hr sessions conducted by a clinical psychologist. At posttreatment, substantial and clinically significant reductions in scores on a range of standardized outcome measures of obsessive-compulsive disorder symptom severity were apparent for all three participants. Crucially, these improvements were maintained at 4-month follow-up. Although further research is clearly warranted, these preliminary findings suggest that DIRT for checkers may prove as effective as DIRT for OC washers.     

Reducing Test Anxiety in School Settings: A Controlled Pilot Study Examining a Group Format Delivery of the Attention Training Technique Among Adolescent Students

Researchers have called for the examination of test anxiety interventions that extend beyond the delivery of individual services by a trained professional. Following from conceptual models and research findings underscoring the importance of metacognitive beliefs to test anxiety, a controlled pilot study examined whether a group format delivery of the attention training technique (ATT) component of metacognitive therapy reduces test anxiety among eighth-grade students. Students completed baseline study measures and were allocated based upon class period to five sessions of ATT (n = 39) or a music listening control (n = 34) delivered within a group format during a school week. Students completed postintervention study measures on the final day of the intervention and completed follow-up study measures approximately 3 weeks following the intervention. As predicted, students receiving ATT reported less postintervention test anxiety than the control when they held stronger baseline metacognitive beliefs about worry. The patterns of findings held at the follow-up and when specifically examining the cognitive (i.e., worry) dimension of test anxiety. Study results suggest that ATT may be a viable test anxiety intervention for students holding heightened metacognitive beliefs about worry. Future directions are discussed.     

VISUAL SCREENING: AN ALTERNATIVE METHOD FOR REDUCING STEREOTYPIC BEHAVIORS

Visual screening, a mildly aversive response suppression procedure, was evaluated across two studies for its effectiveness in reducing topographically similar and dissimilar stereotypic behaviors of four developmentally disabled children. In the first study, a multiple baseline design across subjects and behaviors was used to assess the effectiveness of the procedure as a treatment for reducing the visual and auditory self-stimulatory responses of two 9-yr-old mentally retarded and behaviorally disturbed children. A multiple baseline design across subjects was used in the second study to evaluate the effectiveness of visual screening as a treatment for reducing stereotypic fabric pulling and self-mutilative ear bending, respectively, of two 13-yr-old mentally retarded, autisticlike adolescents. Long-term follow-up data for both studies were reported. The results suggested that visual screening was an easily administered, effective, and exceptionally durable treatment procedure for controlling a variety of stereotypic behaviors commonly associated with the developmentally disabled.