Adolescent AIDS Prevention in Context: The Impact of Peer Educator Qualities and Classroom Environments on Intervention Efficacy

Peer-led, school-based interventions show promise for preventing AIDS among adolescents, but little is known about the processes underlying effective peer education or the conditions that promote its efficacy. This study examined the implementation in one school of an effective, peer-led AIDS prevention program for inner-city 7th-grade participants (n = 123) and identified the qualities of peer educators (n = 15) and classroom environments (n = 5) that contributed to improvement in participants' postintervention AIDS-related attitudes. The Peer Educator Rating Scale was developed to assess two dimensions of participants' perceptions of peer educators: positive regard and perceived similarity. Participants reported greater positive regard for more highly individuated and less shy peer educators, and participants' positive regard for peer educators in turn was associated with lowered AIDS risk as measured by perceptions of peer norms regarding sexual activity and self-efficacy for peer communication regarding sexual topics and condoms. Participants' perceived similarity was not associated with any postintervention improvements in AIDS-related knowledge and attitudes. Participants' classroom membership was associated with improvements in all 5 knowledge and attitude scales, and exploratory classroom-level findings indicated that classroom intervention environments perceived as more organized by participants showed slightly greater overall improvements across AIDS-related knowledge and attitudes scales. Consistent with individual-level findings regarding participants' positive regard for peer educators, the two classrooms with the greatest positive regard for their peer educator teams showed the most student improvement. Implications for further research and the design of future prevention and promotion programs for adolescents are discussed.     

Community-Clinic-Based Parent Intervention Addressing Noncompliance in Children With Attention-Deficit/Hyperactivity Disorder

The current study tested whether an abbreviated version of Defiant Children (Barkley, 1987), an efficacious parent training program to address the behavioral noncompliance often associated with disruptive behavior disorders, could be implemented successfully within a community mental health clinic setting by master's-level therapists. Ethnically and socioeconomically diverse parents of 16 children (ages 4 to 12 years old) completed a 6-session active treatment group emphasizing the use of differential attending skills, effective time-out strategies, and a structured reinforcement schedule to increase child compliance. Pre- and posttreatment measures of attention-deficit/hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), and conduct disorder (CD) symptom level were administered, as well as a measure tapping the contextual breadth (i.e., number of settings) and severity of disruptive behaviors. Parent satisfaction with the treatment was also assessed. Analyses indicated large treatment effects on all measures except CD behavior. Results are discussed in the context of implementing empirically supported therapies in settings where “treatment as usual” is the norm.     

Parent-Child Interaction Therapy for Puerto Rican Preschool Children with ADHD and Behavior Problems: A Pilot Efficacy Study

This study evaluates the initial efficacy of the Parent-Child Interaction Therapy (PCIT) for Puerto Rican preschool children aged 4–6 years with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), combined or predominantly hyperactive type, and significant behavior problems. Thirty-two families were randomly assigned to PCIT ( n =20) or a 3.5-month waiting-list condition (WL; n =12). Participants from both groups completed pretreatment and posttreatment assessments. Outcome measures included child's ADHD symptoms and behavior problems, parent or family functioning, and parents' satisfaction with treatment. ANCOVAs with pretreatment measures entered as covariates were significant for all posttreatment outcomes, except mother's depression, and in the expected direction ( p <.01). Mothers reported a highly significant reduction in pretreatment hyperactivity and inattention and less aggressive and oppositional-defiant behaviors, conduct problems assessed as problematic, parenting stress associated with their child's behavior, and an increase in the use of adequate parenting practices. For the WL group, there were no clinically significant changes in any measure. Treatment gains obtained after treatment were maintained at a 3.5-month follow-up assessment. PCIT seems to be an efficacious intervention for Puerto Rican families who have young children with significant behavior problems.     

Health Perceptions and Anxiety Sensitivity in Patients with Panic Disorder

Separate lines of research indicate that patients with panic disorder display negative perceptions of physical health and elevated fear of autonomic arousal. Because health perceptions and anxiety sensitivity may be related, the present study evaluated the degree to which these constructs can be distinguished in patients meeting DSM-IV criteria for panic disorder (N = 44). Perceived health, anxiety sensitivity, and the clinical features of panic disorder were assessed at pretreatment and following 12 sessions of cognitive–behavioral treatment. Findings consistently indicated that perceived health and anxiety sensitivity can be meaningfully differentiated. Perceived physical health was only moderately associated with anxiety sensitivity, and each was uniquely associated with pretreatment symptomatology and posttreatment end-state functioning. Perceived physical health appears to be a clinically useful index in the overall evaluation of panic disorder and is readily distinguishable from anxiety sensitivity.     

Parent-Child Interaction Therapy for Toddlers: A Pilot Study

Parent-Child Interaction Therapy (PCIT) is an evidence-based program used to treat behavioral disorders in early childhood (2–7 years; Eyberg, 1988 Eyberg , S. ( 1988 ). Parent-Child Interaction Therapy: Integration of traditional and behavioral concerns . Child Family Behavior Therapy , 10 ( 1 ), 33 – 46 .[Taylor & Francis Online] , [Google Scholar]). This article describes a modified version of PCIT for young toddlers (PCIT-T) adapted to meet the developmental needs of children aged 12–24 months. A pilot study was conducted to evaluate the effectiveness of PCIT-T with 29 parent-toddler dyads (children aged <2 years) presenting with significant behavior problems, assessed pretreatment and posttreatment. Outcomes for two groups of older children who participated in PCIT (Group 1: 2–3 years, n = 29; Group 2: 3–4 years, n = 29) were also assessed. Results showed PCIT-T to be associated with a range of positive child and parental outcomes including decreased intensity of disruptive child behaviors, increased parental utilization of PCIT parenting skills, decreased parental depressive symptoms, and high levels of consumer satisfaction with the program. This study provides early evidence that a modified version of PCIT can be successfully used to treat behavior disorders in children aged less than 2 years.     

Training Psychologists for a Future in Evolving Health Care Delivery Systems: Building a Better Boulder Model

Recent and dramatic changes in the demand for and reimbursement of psychological services and expertise in health care delivery systems have radical implications for the preparation of psychologists at the predoctoral, internship, and postdoctoral levels. In order to respond to these changes effectively and advance the profession, training programs must realize the expanded and potential role of psychological expertise in evolving health care delivery systems. In this paper, we review several limitations and unfortunate consequences of traditional training programs that have confined the scope of research and practice to the realm of mental health. We propose that future psychologists be recognized and trained from a broader perspective as behavioral scientists, prepared to operate at the highest levels of health care delivery systems. Specific recommendations for training and education are discussed.     

An exercise in nostalgia: Nostalgia promotes health optimism and physical activity

Objective: Previous research has shown that nostalgia, a sentimental longing for the past, leads to greater feelings of optimism, with other work demonstrating that optimistic thinking (general & health-orientated) is associated with better physical and psychological health. Integrating these two lines of research, the current studies examined whether nostalgia-induced health optimism promotes attitudes and behaviours associated with better physical well-being.

Methods: Participants, in three experiments, were randomly assigned to write about either a nostalgic or ordinary event. Following this, everyone completed a measure of health optimism (Studies 1–3), measures of health attitudes (Study 2) and had their physical activity monitored over the course of 2 weeks (Study 3).

Results: The results revealed that, in comparison to control conditions, nostalgic reverie led to greater health optimism (Studies 1–3). Further, heightened health optimism following nostalgic reflection led to more positive health attitudes (Study 2), and increased physical activity over a two-week period (i.e. Fitbit activity trackers; Study 3).

Conclusions: These findings highlight the importance of nostalgia on health attitudes and behaviours. Specifically, this work suggests that nostalgia can be used as a mechanism to increase the importance, perceived efficacy and behaviour associated with better physical health.     

Nietzsche's agon with ressentiment: towards a therapeutic reading of critical transvaluation

This paper examines the therapeutic implications of Nietzsche's critique of ressentiment and revenge as our signature malady. §I examines the obstacles to a therapeutic reading of Nietzsche's thought, including his anti-teleological tendencies and the value he places on sickness. Then there is the energetic problem of finding resources to tackle ressentiment, given the volitional exhaustion of modern nihilism. Finally, the self-referential implications of Nietzsche's critique of slave values threaten to trap his thought in a futile ressentiment against ressentiment. If the impulse to cure or redeem us from revenge through critical destruction repeats the logic of revenge, then the challenge for a therapeutic reading is to think through the transformation of revenge on the basis of repetition.An agonal reading of Nietzsche's philosophical practice is proposed to tackle these problems in §II.In Homer's Contest (1872), Nietzsche describes the transference (Übertragung) of Hesiod's evil Eris – goddess of war and destruction – into the good Eris of the contest or agon: destructive impulses are affirmed as stimulants, but also transformed into culture-building forces through an agonal regime of limited aggression. By superimposing this regime, as a model for Nietzsche's textual confrontations, on their unconscious text of embodied ressentiment, a therapeutic perspective emerges, based on three principles: affirmation; mutual empowerment; and externalisation. The agon performs an affirmative transformation of revenge on the basis of a fertile repetition: destructive affects (as in ressentiment) are transferred into constructive deeds of mutual antagonism. Through Nietzsche's agonal discourse, a reactive regime of internalised aggression is externalised in active deeds of limited philosophical aggression – a therapeutic transformation of (self-)destructive into constructive, philosophical impulses.     

Change in subjective social status following HIV diagnosis and associated effects on mental and physical health among HIV-positive gay men in Australia

Objective: This study investigates the impact of HIV diagnosis on subjective social status and if changes are linked to health outcomes.

Design: Two measures of subjective social status, socio-economic and standing in the community were examined in 342 Australian HIV-positive gay men in 2014. Participants recalled ratings at diagnosis were compared with current ratings.

Main outcome measures: Self-reported mental (psychological distress, self-esteem, positive mental health and satisfaction with life) and physical health (self-rated health, CD4 count, viral load).

Results: Half of the participants reported improvements in subjective socio-economic status (59%) or standing in the community (52%) since diagnosis, yet one quarter reported socio-economic status (25%) or standing in the community had decreased (23%). Increases in either measure of subjective social status were linked to higher self-esteem, positive mental health, satisfaction with life and better self-rated health. Decreases in subjective social status, however, were strongly linked to poorer outcomes on all mental health measures. Decreases in standing in the community were also associated with poorer physical self-rated health.

Conclusion: Most participants reported their subjective social status were the same or better since diagnosis. Changes in subjective social status following diagnosis were strongly linked to mental health outcomes. Those who reported a decrease in subjective social status were particularly vulnerable to mental health problems.     

Attitudes,leprechauns and neutrinos: The ontology of behavioral science

Conclusion Although the historical dispute between introspective psychology and ontological behaviorism encourages the belief that attitudes do not exist, this belief is misguided. Even the Hacking test, suggested by someone with grave doubts about behavioral science, supports the claim that attitudes are just as real as neutrinos. Nevertheless, the progress of a science of attitudes may be severely limited by the influence of exogenous factors, factors including normative beliefs about how we should treat the people to whom attitudes are attributed. In so far as these beliefs prevent scientists from experimenting on people and their institutions, particle physics has resources unavailable to survey research. Thus a serious examination of behavioral science leads to some surprising conclusions as to which sciences are the hard ones and which ones are simply easier.Thanks are due to a number of people, particularly to Ted Jelen for invaluable advice and encouragement and editorial assistance and to Paul Teller, Dorothy Grover and my colleagues in the Indiana Philosophical Association for helpful and insightful comments. Research for this paper was supported by Faculty Development of DePauw University and the Humanities Division of Illinois Benedictine College.     

Group cognitive-behavioral therapy for anxiety in a clinic setting: does child involvement predict outcome?

The current study examined the relationship between child involvement and treatment outcome in a group cognitive–behavioral treatment (GCBT) program for children with anxiety, using an adapted version of the Child Involvement Rating Scale (CIRS). Thirty-four children with a primary diagnosis of an anxiety disorder, referred for outpatient treatment at a hospital, and their parents participated in a manualized 12-session GCBT program. The Multidimensional Anxiety Scale for Children (MASC), administered at pretreatment, posttreatment, and at 4-month follow-up, served as the outcome measure. The psychometric properties of the adapted CIRS were good. Early involvement (EI) was calculated as the average score from Sessions 1 to 6 and late involvement (LI), the average score from Sessions 7 to 12. EI predicted lower MASC scores at posttreatment, after controlling for pretreatment MASC scores and for LI, B = – 1.05, t(3) = – 2.34, p < .05. EI did not predict outcomes at follow-up. Results were replicated using the original CIRS measure. Exploratory analyses suggested that the relationship between LI and treatment outcomes was moderated by medication. Involvement in therapy prior to exposures might be an important predictor of posttreatment outcomes in GCBT in a community setting.     

Randomized Controlled Trial of a Smartphone Application as an Adjunct to Acceptance and Commitment Therapy for Smoking Cessation

There is a major public health need for innovative and efficacious behavioral and cognitive interventions for smoking cessation. This randomized controlled trial evaluated the efficacy of an acceptance and commitment therapy (ACT) smartphone application in augmenting ACT group treatment for smoking cessation. One hundred fifty adults smoking 10 or more cigarettes per day were randomly assigned to 6 weekly group sessions of behavioral support, ACT, or ACT combined with the smartphone application. Access to the app was provided from the start of the in-person treatment until the 6-month follow-up assessment. Participants were encouraged to make their quit attempts after the third session, and the posttreatment assessment occurred 3 weeks later. Measures of smoking status and ACT processes were obtained at baseline, posttreatment, and 6-month follow-up. Biochemically verified quit rates in the combined, ACT, and behavioral support groups were 36% (p = .079 relative to ACT; p = .193 relative to behavioral support), 20% (p = .630 relative to behavioral support) and 24% at posttreatment, as compared with 24% (p = .630 relative to behavioral support), 24% (p = .630 relative to behavioral support) and 20% at follow-up. There was no significant difference (p = > .999) in the primary outcome of biochemically verified 7-day point-prevalence abstinence at 6-month follow-up between the combined and ACT groups. The combined group reported significantly greater smoking reduction, acceptance and present-moment awareness than the behavioral support group at posttreatment, but not at follow-up. There were no significant differences between the groups in positive mental health. Contrary to hypotheses, the ACT group did not display significant improvements in positive mental health or ACT processes relative to the behavioral support group at posttreatment or follow-up. Implications and directions for future research are discussed.     

Toward a cognitive-behavioral model of child psychopathology and a critique of related interventions

A cognitive- behavioral model recognizes the interdependencies of cognitive, affective, social, developmental, and behavioral factors in the etiology and remediation of childhood psychopathology. The model is concerned with the cognitive distortions and deficiencies that surround behavioral events and emphasizes the combination of treatment strategies with the therapist as a remediation organizer. Recommendations are made regarding treatment expectations, the specificity of the cognition-disorder relationship, the quality of the application of the training, and the need for further involvement of the child in the therapeutic curriculum.Portions of this paper were adapted from an address given at the Instituto Nacional De Salud Mental Honorio Delgado-Hideyo Noguchi, Lima, Peru, December 1984. Portions were also presented as part of a colloquium at Rutgers University. I wish to thank Kelly Bemis for her helpful comments on an earlier draft of this paper.     

Internetbasierte Gesundheitsinterventionen

Background

Internet-based health interventions can serve as a useful supplement to regular face-to-face therapy only if they are accepted by the clients.

Objective

This aim of the current study was to examine the attitudes and opinions of potential users on internet-based health interventions in Germany. This information could make a useful contribution to the development and promotion of measures which target their requirements.

Material and methods

To address this issue psychotherapy patients and persons on a waiting list for outpatient psychotherapy were interviewed about their attitudes towards internet-based interventions and compared with the results from a matched control group.

Results

Compared with the control group, waiting list candidates in particular declared a reduced interest in engaging in internet-based interventions and both patient groups perceived few advantages. All groups appreciated the enhanced flexibility associated with internet-based interventions, but both patient groups thought that the increased anonymity and reduced inhibition threshold for seeking treatment were less advantageous than the control group. Compared to the controls, both patient groups worried more about privacy issues and a possible misinterpretation of their written statements. Both patient groups considered internet-based psychotherapy as conceivable for the treatment of fewer kinds of psychopathological symptoms than the control group. Patients considered that internet-based treatment of panic disorder, posttraumatic stress disorder, depression and generalized anxiety disorder was least imaginable although, to date, relatively many internet-based options are available for these disorders. There appears to be interest in the treatment of sexual dysfunctions through the internet.

Conclusion

To address the reservations concerning privacy protection, paper and pencil registration procedures could be provided. In addition, by clearly emphasizing that there is the possibility of establishing personal contact to a therapist either face to face or by video conference, internet-based services could also be more useful in satisfying patient needs.

     

The fallacy of fallacies

Several of the so-called fallacies in Aristotle are not in fact mistaken inference-types, but mistakes or breaches of rules in the questioning games which were practiced in the Academy and in the Lyceum. Hence the entire Aristotelian theory of fallacies ought to be studied by reference to the author's interrogative model of inquiry, based on his theory of questions and answers, rather than as a part of the theory of inference. Most of the fallacies mentioned by Aristotle can in fact be diagnosed by means of the interrogative model, including petitio principii, multiple questions, babbling, etc., and so can Aristotle's alleged anticipation of the fallacy of argumentum ad hominem. The entire Aristotelian conception of inquiry is an interrogative one. Deductive conclusions caught Aristotle's attention in the form of answers that every rational interlocutor must give, assuming only his own earlier answers. Several features of Aristotle's methodology can be understood by means of the interrogative model, including the role of endoxa in it. Theoretically, there is also considerable leeway as to whether fallacies are conceived of as mistakes in questioning or as breaches of the rules that govern questioning games.     

On a complexity-based way of constructivizing the recursive functions

Let g _E(m, n)=o mean that n is the Gödel-number of the shortest derivation from E of an equation of the form (m)=k. Hao Wang suggests that the condition for general recursiveness mn(g _E(m, n)=o) can be proved constructively if one can find a speedfunction _{s s}, with _s(m) bounding the number of steps for getting a value of (m), such that mn _s(m) s.t. g _E(m, n)=o. This idea, he thinks, yields a constructivist notion of an effectively computable function, one that doesn't get us into a vicious circle since we intuitively know, to begin with, that certain proofs are constructive and certain functions effectively computable. This paper gives a broad possibility proof for the existence of such classes of effectively computable functions, with Wang's idea of effective computability generalized along a number of dimensions.We are grateful to an anonymous referee for Studia Logica for valuable advice leading to substantial improvements in the presentation of the main definitions and theorem.     

Adolescent Satisfaction with School-Based Mental Health Services

Examining adolescents' satisfaction with mental health services is an important program evaluation activity. Their perceptions of whether services were beneficial and resulted in improved functioning are indices of treatment quality. Assessment of adolescent satisfaction with school-based mental health programs has been limited. In our study, adolescents receiving services from a School Mental Health Program (SMHP) completed satisfaction surveys. Participants were predominantly minority youth residing in an urban area. Results indicated that students were highly satisfied with their mental health services. Students valued the therapeutic relationship, catharsis associated with therapy, and skills they learned during therapy. Several factors influenced satisfaction ratings including clinician training and availability.     

Health-related quality of life in transgender adolescents: Associations with body image and emotional and behavioral problems

Background: Transgender adolescents who apply for treatment often experience a marked increase in body-related distress when entering puberty, accompanied by internalizing problems and poor peer relations. Although adolescence is a time of considerable psychosocial and physical change, generally associated with a decline in health-related quality of life (HRQoL), research on HRQoL in transgender youth and possible predictors is sparse. This study thus aims to explore the predictive value of body image factors and emotional and behavioral problems for HRQoL.

Methods: This cross-sectional one-group observational study was carried out at the Child and Adolescent psychiatric department (Gender Identity Service) in Hamburg, Germany. A sample of n = 126 (103 trans male and 23 trans female) adolescents, who were referred for counseling and/or treatment completed different standardized instruments before undergoing any sort of treatment. Firstly, five dimensions of HRQoL were explored in transgender adolescents and secondly, a linear regression model was applied to assess the impact of body image and emotional and behavioral problems on overall HRQoL.

Results: HRQoL was generally impaired in transgender adolescents compared to norm scores, especially with regard to aspects of psychological and physical well-being. Linear regression analysis revealed that greater internalizing problems and less body satisfaction significantly predicted lower HRQoL outcomes.

Conclusions: Impaired HRQoL may be explained by high degrees of internalizing problems and low body satisfaction. Thus, one important aim of mental health professionals working with youth should be to provide appropriate treatment and counseling options that may contribute to overall well-being in the long-term.     

Psychology and Medical Rehabilitation: Moving Toward a Consumer-Driven Health Care System

Changes in health care will provide both opportunities and threats for rehabilitation psychologists. We must demonstrate the relevance of our clinical services to important outcomes or risk being excluded as treatment providers. With shifts to nonhospital settings, we can provide increasing clinical and administrative leadership. However, we must redefine models of treatment to include home care and telepsychology, practice guidelines and critical paths, involvement of paraprofessionals, case management, injury prevention, and health promotion. We should be involved when datasets are established to define disability-related health policies and reimbursement and be proactive in Medicare, Medicaid, and managed care reform to develop treatment packages to decrease long-term handicap. Collaboration with consumers is critical. We must frame research questions to address current policy issues. Our skills can help improve the effectiveness of human behavior, whether it be patients with illness, consumers with disability, health care providers, health systems managers, or legislators.     

Reflections on thomism and client-centered psychotherapy

Conclusion To summarize, Rogers and Aquinas both stress the importance of existential experience and sense data. Although Rogers is more concerned with human freedom and being than are many modern adjustment psychotherapists, he is still circumscribed by his initial positivistic assumptions about the nature of man in his therapy. but these assumptions may be in the process of change.But like Aquinas, Rogers has a deep respect for the person, a respect for his emotions, a respect for his whole existential being.³⁸ Rogers once stated that the client-centered point of view is devoid of thequid pro quo aspect of most experiences we call love. It is the simple outgoing human feeling of one individual for another, a feeling it seems ... which is even more basic than sexual or parental feelings. It is a caring enough about the person that you do not wish to interfere with his development, nor to use him for any self-aggrandizing goals of your own. Your satisfaction comes in having set him free to grow in his own fashion.³⁹ Isn't this the spiritual detachment of real Christian love?He has taught at the University of California at Los Angeles and at Loyola University (Los Angeles), and has been a staff psychologist at the Metropolitan State Hospital, Los Angeles. He is a member of the American Psychological Association and the American Academy of Psychotherapists.Portions of this paper were presented at the 16th Annual Scientific Session, Guild of Catholic Psychiatrists, Los Angeles, 1964.