Cancer Family History Reporting: Impact of Method and Psychosocial Factors

Family history is one the greatest risk factors for disease and one of the most important informational tools in medical genetics for the purpose of diagnosis, risk assessment, prevention and treatment. However, research is needed on the comparability of different methods of cancer family history assessment and the influence of psychosocial factors in family history reports. The purpose of this study was to determine if individuals had discrepancies between written and interview reports of cancer family history and the role of psychosocial factors in these discrepancies. Oncology patients (n=104) were administered a survey to assess psychosocial factors (i.e., information-seeking, worry, perceived risk, and health literacy) and were asked to provide family history in a written and an interview form. Randomization determined which form individuals received first. No differences in the amount of missing data or the amount of unspecified data were noted between the written and interview method. Psychosocial factors did not differentiate between those who had discrepancies in family history reports and those who did not have discrepancies in family history reports; although there was a trend for those with lower literacy and those who were blunters to be more discrepant on type of cancer diagnosis. In sum, this preliminary study indicates that written and interview methods of family history assessment for first degree relatives may be used interchangeably. The ability to use written methods will facilitate collection of basic family history information in the oncology clinic.     

Predicting Stereotype Threat,Test Anxiety,and Cognitive Ability Test Performance: An Examination of Three Models

As the classroom and workplace, among other contexts, become more diverse in their population characteristics, the need to be aware of specific factors impacting testing outcome issues correspondingly increases. The focus in this study, among other purposes, was to identify possible interactions between examinee's individual-difference characteristics (e.g., personality) and characteristics of the testing environment on test anxiety reactions and cognitive ability test performance. This study assessed reactions and performance in 4 different testing conditions through a path-analytic testing of 3 well-established theoretical models of stress appraisal and coping (i.e., cognitive appraisal, personality trait, and transactional). The transactional model, incorporating both personality and testing condition factors, was best in predicting the variance associated with the cognitive ability test scores, the 3 test anxiety score indexes (i.e., social derogation, physical tenseness, and cognitive obstruction), and the stereotype threat scores. With personality traits, for example, agreeableness was a relatively strong and consistent predictor of all study measures. Regarding testing condition factors, only the manipulation of stereotype threat level (low or high) produced some significant accounting of variance. Higher perceived stereotype threat levels were generally associated with heightened stereotype threat belief perceptions, lower cognitive ability test scores, and, interestingly, reduced feelings of cognitive obstruction in test anxiety.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

Cognitive processes in dissociation: an analysis of core theoretical assumptions

Dissociation is typically defined as the lack of normal integration of thoughts, feelings, and experiences into consciousness and memory. The present article critically evaluates the research literature on cognitive processes in dissociation. The authors' review indicates that dissociation is characterized by subtle deficits in neuropsychological performance (e.g., heightened distractibility). Some of the cognitive phenomena (e.g., weakened cognitive inhibition) associated with dissociation appear to be dependent on the emotional or attentional context. Contrary to a widespread assumption in the clinical literature, dissociation does not appear to be related to avoidant information processing. Rather, it is associated with an enhanced propensity toward pseudo-memories, possibly mediated by heightened levels of interrogative suggestibility, fantasy proneness, and cognitive failures. Evidence for a link between dissociation and either memory fragmentation or early trauma based on objective measures is conspicuously lacking. The authors identify a variety of methodological issues and discrepancies that make it difficult to articulate a comprehensive framework for cognitive mechanisms in dissociation. The authors conclude with a discussion of research domains (e.g., sleep-related experiences, drug-related dissociation) that promise to advance our understanding of cognition and dissociation.     

Maternal Prenatal Stress and Other Developmental Risk Factors for Adolescent Depression: Spotlight on Sex Differences

Maternal stress during pregnancy has been linked to premorbid abnormalities associated with depression (e.g., difficult temperament, cognitive deficits) in offspring. However, few studies have looked across developmental periods to examine maternal stress during pregnancy and offspring depression during adolescence and whether these associations differ by sex. The current study used data from 1711 mother-offspring dyads (offspring sex: 49.8% male) in a longitudinal birth cohort study. Maternal narratives collected during pregnancy were qualitatively coded for stress-related themes by independent raters. Latent class analysis (LCA) identified distinct subgroups of offspring based on exposure to maternal prenatal stress and other developmental factors from the prenatal, childhood, and adolescent periods that have been associated with depression and/or maternal prenatal stress. LCA identified subgroups that were compared to determine whether and to what extent they differed on adolescent depressive symptoms. LCA revealed a subgroup of “high-risk” individuals, characterized by maternal factors during pregnancy (higher ambivalence/negativity and lower positivity towards the pregnancy, higher levels of hassles, lower maternal education and higher maternal age at birth, higher pre-pregnancy BMI) and offspring developmental factors (decreased cognitive functioning during childhood and adolescence, lower perceived parental support during adolescence, and higher levels of maternal depression during adolescence). High-risk females exhibited elevated conduct symptoms and higher birth order, while high-risk males exhibited decreased internalizing symptoms and lower birth order. Both high-risk males and females reported elevated depressive symptoms during adolescence relative to their “low-risk” counterparts.     

A developmental-contextual model of depressive symptoms in Mexican-origin female adolescents

The current study tested a developmental-contextual model of depressive symptomatology among Mexican-origin, female early and middle adolescents and their mothers. The final sample comprised 271 dyads. We examined the interrelations among cultural (i.e., acculturation dissonance), developmental (i.e., pubertal development and autonomy expectation discrepancies), and interpersonal (i.e., mother-daughter conflict and maternal supportive parenting) factors in predicting adolescents' depressive symptoms. For both early and middle adolescents, maternal support was negatively associated with mother-daughter conflict and depressive symptoms. Mother-daughter autonomy expectation discrepancies were positively associated with mother-daughter conflict, but this association was found only among early adolescents. Further, mother-daughter acculturation dissonance was positively associated with mother-daughter conflict but only among middle adolescents. Findings call for concurrently examining the interface of developmental, relational, and cultural factors in predicting female adolescents' depressive symptomatology and the potential differences by developmental stage (e.g., early vs. middle adolescence).     

Measuring informant discrepancies in clinical child research

Discrepancies among informants' ratings of child psychopathology have important implications for diagnosis, assessment, and treatment. Typically, parents and children complete measures (e.g., self-report checklists, diagnostic instruments) to assess child dysfunction. Ratings gathered from these sources reveal relatively little agreement on the nature and extent of the child's social, emotional, and behavioral problems. This article reviews and illustrates the most frequently used methods of measuring informant discrepancies in the clinical child literature (i.e., raw difference, standardized difference, and residual difference scores) and outlines key considerations to influence their selection. The authors conclude that frequently used methods of measuring informant discrepancies are not interchangeable and recommend that future investigations examining informant discrepancies in clinical child research use the standardized difference score as their measure of informant discrepancies.     

单维项目因素分析：CCFA与IRT估计方法的比较

当观测指标变量为二分分类数据时,传统的因素分析方法不再适用。作者简要回顾了SEM框架下的分类数据因素分析模型和IRT框架下的测验题目和潜在能力的关系模型,并对两种框架下主要采用的参数估计方法进行了总结。通过两个模拟研究,比较了SEM框架下GLSc和MGLSc估计方法与IRT框架下MML/EM估计方法的差异。研究结果表明：（1）三种方法中,GLSc得到参数估计的偏差最大,MGLSc和MML/EM估计方法相差不大;（2）随着样本量增大,各种项目参数估计的精度均提高;（3）项目因素载荷和难度估计的精度受测验长度的影响;（4）项目因素载荷和区分度估计的精度受总体因素载荷（区分度）高低的影响;（5）测验项目中阈值的分布会影响参数估计的精度,其中受影响最大的是项目区分度。（6）总体来看,SEM框架下的项目参数估计精度较IRT框架下项目参数估计的精度高。此外,文章还将两种方法在实际应用中应该注意的问题提供了一些建议。     

The effect of life events and exercise program format on the adoption and maintenance of exercise behavior.

This study prospectively investigated the effects of major life events on subsequent exercise adherence rates of individuals (N = 173) participating in a 2-year, randomized, controlled clinical trial of 3 different exercise conditions (higher-intensity home-based; lower-intensity home-based; and higher-intensity class-based). For 3 of 4 6-month exercise-adherence periods, an analysis of variance indicated a significant main effect (p < .05) for major life events. Compared with participants reporting 0 or 1 major life event, exercise adherence in the maintenance phase was significantly lower for those reporting 3 or 4 major life events regardless of the exercise condition. No significant life-event-exercise-adherence relationship was found in the adoption phase of exercise participation (i.e., Months 1 to 6). The deleterious effect of life events emphasizes the importance of instruction regarding how to prepare for high-risk situations that can lead to missed exercise sessions or to program attrition.     

Cultural estrangement: the role of personal and societal value discrepancies

Study 1 examined whether cultural estrangement arises from discrepancies between personal and societal values (e.g., freedom) rather than from discrepancies in attitudes toward political (e.g., censorship) or mundane (e.g., pizza) objects. The relations between different types of value discrepancies, estrangement, subjective well-being, and need for uniqueness also were examined. Results indicated that personal-societal discrepancies in values and political attitudes predicted estrangement, whereas mundane attitude discrepancies were not related to estrangement. As expected, value discrepancies were the most powerful predictor of estrangement. Value discrepancies were not related to subjective well-being but fulfilled a need for uniqueness. Study 2 replicated the relations between value discrepancies, subjective well-being, and need for uniqueness while showing that a self-report measure of participants' values and a peer-report measure of the participants' values yielded the same pattern of value discrepancies. Together, the studies reveal theoretical and empirical benefits of conceptualizing cultural estrangement in terms of value discrepancies.     

CBT for Medication Adherence and Depression (CBT-AD) in HIV-Infected Patients Receiving Methadone Maintenance Therapy

For individuals with HIV who are current or former injection drug users, depression is a common, distressing condition that can interfere with a critical self-care behavior—adherence to antiretroviral therapy. The present study describes the feasibility and outcome, in a case series approach, of cognitive behavioral therapy to improve adherence and depression (CBT-AD) among individuals with HIV and depression undergoing methadone maintenance treatment for heroin dependence. CBT-AD integrates cognitive behavioral therapy for depression with our intervention for improving adherence to antiretroviral therapy for HIV (Life-Steps; [Safren, S. A., Otto, M. W., Worth, J., Salomon, E., Johnson, W., Mayer, K., et al. (2001). Two strategies to increase adherence to HIV antiretroviral medication: Life-Steps and medication monitoring. Behavioral Research and Therapy, 39, 1151–1162]). Specifically, in CBT-AD, patients first receive a cognitive behavioral intervention focusing on improving skills related to medication adherence. Each of the subsequent CBT modules (activity scheduling, cognitive restructuring, problem-solving training, and relaxation training/diaphragmatic breathing) is designed to address both self-care/adherence behaviors as well as depression. The process and outcome with 4 cases suggest that the treatment was feasible and acceptable and was generally associated with improvements. This case series provides an example of how cognitive behavioral therapists can integrate the treatment of depression with the enhancement of critical self-care behaviors in the context of highly complex, medical and psychiatric comorbidity.     

时距估计中的锚定效应

采用两种时距估计方法,检验时距锚定值对时距估计的影响,并探讨了时距信息的心理表征方式。63名在校大学生参加了本次实验。实验1采用口头报告法,表明较大的时距锚定值（5s,5000ms）条件下,被试估对时距的估计值较大,而较小时距锚定值（1s,1000ms）条件下被试估计的时距值较小;语义相同但表述方式不同的锚定值（1s与1000ms,5s与5000ms）条件下的时距估计值没有显著差异。实验2采用产生法,进一步表明时距表述方式对产生时距没有显著影响。以上结果表明,时距估计受时距锚定值的影响,时距信息可能以语义形式进行表征,而不是简单的数字加单位的表层表征形式     

主动性和反应性认知控制的权衡机制及影响因素

主动性控制和反应性控制是认知控制研究的新视角。前者通过在反应前维持目标相关信息的表征来预防冲突, 后者在反应时重激活目标相关信息以解决冲突。个体能够在这两种认知控制间进行权衡从而形成最优反应。通过AX-CPT等实验范式, 辅以ERP、fMRI技术可分离两种认知控制, 并观察到认知控制相关的脑区在激活时间和强度上的差异。个体生理发展、认知因素(期望、流体智力、训练)、非认知因素(情绪、动机等)均能影响认知控制的权衡。未来的研究应多关注这一权衡的内在神经机制和认知机制, 并与传统认知控制研究相结合, 在理论和应用上取得更进一步的发展。     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.     

Altruism and health outcomes in multiple sclerosis: The effect of cognitive reserve

Despite age-associated decreases in cognitive and physical abilities, age is not associated with a decrease in ratings of well-being; this phenomenon is termed the ‘paradox of well-being.’ One potential explanation for this paradox may be that older adults place less value on cognitive abilities that have been shown to decrease with age (e.g., memory) and more value on cognitive abilities shown to increase with age (e.g., knowledge). Using online methods, 358 individuals between the ages of 18 and 88 completed a survey assessing the values placed on everyday cognitive abilities, self-ratings for those same abilities, and life satisfaction. Results indicated that there were minimal age-related differences in values placed on everyday cognitive abilities and that values generally did not moderate the relationship between perceptions of cognitive functioning and life satisfaction. Of note, values placed on cognition significantly predicted life satisfaction in younger adults, but not in middle-aged and older adults.     

Bifactor and item response theory analyses of interviewer report scales of cognitive impairment in schizophrenia

A psychometric analysis of 2 interview-based measures of cognitive deficits was conducted: the 21-item Clinical Global Impression of Cognition in Schizophrenia (CGI-CogS; Ventura et al., 2008), and the 20-item Schizophrenia Cognition Rating Scale (SCoRS; Keefe et al., 2006), which were administered on 2 occasions to a sample of people with schizophrenia. Traditional psychometrics, bifactor analysis, and item response theory methods were used to explore item functioning and dimensionality and to compare instruments. Despite containing similar item content, responses to the CGI-CogS demonstrated superior psychometric properties (e.g., higher item intercorrelations, better spread of ratings across response categories) relative to the SCoRS. The authors argue that these differences arise mainly from the differential use of prompts and how the items are phrased and scored. Bifactor analysis demonstrated that although both measures capture a broad range of cognitive functioning (e.g., working memory, social cognition), the common variance on each is overwhelmingly explained by a single general factor. Item response theory analyses of the combined pool of 41 items showed that measurement precision is peaked in the mild to moderate range of cognitive impairment. Finally, simulated adaptive testing revealed that only about 10 to 12 items are necessary to achieve latent trait level estimates with reasonably small standard errors for most individuals. This suggests that these interview-based measures of cognitive deficits could be shortened without loss of measurement precision.     

Cognitive Enhancement Strategies to Augment Cognitive-Behavioral Therapy for Anxiety and Related Disorders: Rationale and Recommendations for Use With Cognitively Healthy Older Adults

Cognitive-behavioral therapy (CBT) is widely recognized as an efficacious treatment of anxiety and related disorders—however, recent research suggests that some older adults may derive reduced benefit from CBT as compared to younger adults. Age-related declines in cognition (e.g., memory, attention) may be a contributing factor to the reduced benefit seen in this population. Augmentation strategies for optimizing CBT are now under way (e.g., exercise, medication), and indicate that cognitive support and enhancement strategies can improve both cognitive skills and treatment outcome in anxious older clients. This review discusses the current literature on enhancement strategies that target CBT aptitude directly (e.g., memory aids for therapeutic material) and indirectly (e.g., use of standardized cognitive tasks unrelated to CBT) as methods of augmenting CBT. Recommendations for clinicians and directions for future research are provided.     

Longitudinal associations among quality of life and its predictors in patients treated for prostate cancer: the moderating role of age

This study examined moderating effects of age on longitudinal associations among quality of life (QOL) and its demographic (e.g., age), clinical [e.g., prostate-specific antigen (PSA) level], and affective and cognitive predictors (i.e., distress, worries about recurrence, decisional regret, subjective life expectancy) in prostate cancer patients treated with external beam radiation (N = 391). Demographic and clinical characteristics were assessed at diagnosis, affective and cognitive variables at 6 months after diagnosis, and QOL at 12 months after diagnosis. Multiple-group analyses showed that among younger patients (< or =68 years old, n = 199), lower levels of decisional regret were associated with better functional QOL, and lower Gleason scores and PSA levels were associated with lower levels of distress and longer expected survival time, respectively. Being employed was related to higher levels of functional QOL and frequent worries about recurrence. Among older patients (>68 years old, n = 192), lower levels of distress were associated with higher levels of functional QOL, and longer expected survival time was associated with better functional and physical QOL.