Improving access to psychological treatments: lessons from developing countries

Even though psychological treatments have been advocated as treatments for a range of mental disorders by the WHO for scaling up through primary care globally, the vast majority of potential beneficiaries are unable to access these treatments. Two major barriers impede the path between evidence based treatments and improved access: the lack of skilled human resources and the acceptability of treatments across cultures. This essay synthesizes the experiences of programs which developed and evaluated psychological treatments for depression in three resource poor developing countries. These programs addressed the human resource barrier by training lay or community health workers to deliver the treatments and addressed the acceptability barrier by systematically adapting the treatment to contextual factors. All programs demonstrated significant benefits in recovery rates when compared with usual care demonstrating the effectiveness of the approach. The implications for these experiences to improving access to psychological treatments in the global context are discussed.     

Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral

Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N?=?293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.     

A comparative study of robust tests for spread: Asymmetric trimming strategies

We examined 633 procedures that can be used to compare the variability of scores across independent groups. The procedures, except for one, were modifications of the procedures suggested by Levene (1960) and O'Brien (1981). We modified their procedures by substituting robust measures of the typical score and variability, rather than relying on classical estimators. The robust measures that we utilized were either based on a priori or empirically determined symmetric or asymmetric trimming strategies. The Levene‐type and O'Brien‐type transformed scores were used with either the ANOVA F test, a robust test due to Lee and Fung (1985), or the Welch (1951) test. Based on four measures of robustness, we recommend a Levene‐type transformation based upon empirically determined 20% asymmetric trimmed means, involving a particular adaptive estimator, where the transformed scores are then used with the ANOVA F test.     

I recognize your face, but I can't remember your name: A question of expertise?

In four experiments on the identification of familiar faces we reassessed a robust performance pattern—namely, the temporal advantage for retrieving biographical facts as compared to recalling proper names, which has been interpreted as reflecting a serial ordering of the access to semantic and name information. Evidence for recent parallel accounts had been provided by Scanlan and Johnston (1997) who reported an advantage for name retrieval in children. Here we replicated the findings of Scanlan and Johnston but also showed that the naming advantage disappears, and performance is very similar to that of adults when stimuli and tasks are used that are familiar to children. Conversely, we also demonstrated an advantage for name retrieval in adults when highly unfamiliar semantic facts were associated with the faces. Together these findings suggest that there is no fundamental difference in the cognitive architectures of children and adults. The experiments indicate that the relative speed of naming and semantic fact retrieval depends on the expertise with the semantic facts to be retrieved. Implications for models of face identification and naming are discussed.     

THE EFFECTS OF A GOOD BEHAVIOR GAME ON THE DISRUPTIVE BEHAVIOR OF SUDANESE ELEMENTARY SCHOOL STUDENTS

An endemic version of the Good Behavior Game was applied in a rural Sudanese second-grade classroom. Official letters of commendation, extra time for recess, victory tags, and a winner's chart were used as backup reinforcers. The class was divided into two teams, and the teacher indicated she would place a check on the board after every rule violation. The students were also told that the team with the fewest marks would win the game and receive the aforementioned prizes. After an initial adaptation period, the rate of disruption was charted across four treatment phases: viz., baseline I, introduction of the game, baseline II, and reintroduction of the game. It was observed that the game phases were associated with marked decreases in the rate of seat leaving, talking without permission, and aggression. The teacher, principal, parents, and students were consequently individually interviewed, and their comments spoke strongly for the social validity of the game.     

Psychoticism and response to treatment in neurotic patients

A study is reported of neurotic patients at St. Bartholomew's Hospital, London, who were given the Eysenck Personality Questionnaire and who were rated by their doctors for prognosis and final assessment after treatment. The results indicated that those patients who had elevated psychoticism scores took longer to improve and that doctors rated them harder to treat at final assessment. It is suggested that early knowledge of patients with a poor prognosis, in the form of their Psychoticism score, might prove helpful to psychiatrists and psychologists, both for diagnosis and (primarily) for choice of appropriate treatment.     

Allocentric spatial memory in humans with hippocampal lesions

An immersive virtual reality (IVR) system was used to investigate allocentric spatial memory in a patient (PR) who had selective hippocampal damage, and also in patients who had undergone unilateral temporal lobectomies (17 right TL and 19 left TL), their performance compared against normal control groups. A human analogue of the Olton [Olton (1979). Hippocampus, space, and memory. Behavioural Brain Science, 2, 315] spatial maze was developed, consisting of a virtual room, a central virtual circular table and an array of radially arranged up-turned 'shells.' The participant had to search these shells in turn in order to find a blue 'cube' that would then 'move' to another location and so on, until all the shells had been target locations. Within-search errors could be made when the participants returned to a previously visited location during a search, and between-search errors when they revisited previously successful, but now incorrect locations. PR made significantly more between-search errors than his control group, but showed no increase in within-search errors. The right TL group showed a similar pattern of impairment, but the left TL group showed no impairment. This finding implicates the right hippocampal formation in spatial memory functioning in a scenario in which the visual environment was controlled so as to eliminate extraneous visual cues.     

Adult Intimate Relationships and Psychological Adjustment

This study explored relations among perceived acceptance and behavioral control by intimate partners, remembrances of parents’ acceptance and behavioral control in childhood, and adults’ psychological adjustment. The study was conducted on 98 American adults (50 men and 48 women) between ages 18 and 50 (mean 26 years). Measures used were the Adult version of the Parental Acceptance-Rejection/Control Questionnaire for Mothers and Fathers(Adult PARQ/Control: Mother and Father); Intimate Partner Acceptance-Rejection/Control Questionnaire (IPAR/CQ); and, the Adult version of the Personality Assessment Questionnaire (Adult PAQ). Results showed significant positive correlations between psychological adjustment and perceived partner acceptance and parental acceptance for both women and men. Results also showed significant negative correlations between psychological adjustment and perceived partner control and parental control for both women and men. Regression analyses, however, revealed a significant independent effect of only paternal acceptance (but not of maternal and partner acceptance) on the psychological adjustment of men. Regression analyses also revealed significant independent effects of both paternal and maternal acceptance (but not partner acceptance) on the psychological adjustment of women.     

Analysis of rainfall impacts on platooned vehicle spacing and speed

This paper investigates the impact of rainfall on the behavior of drivers in a car-following state by analyzing the differences in time gap, speed, and following distance of platooned vehicles between no-rain and rainy weather conditions on a two-lane rural state highway. Time gap, following distance, and individual vehicle speed were observed. Platooned vehicles were identified by a maximum time gap threshold of 4 s, allowing for interactions between vehicles beyond perception–reaction time. Rainfall intensity was utilized as the measure of local precipitation conditions and was categorized according to American Meteorological Society standards. The analysis showed that rainy weather conditions were strongly correlated with greater spread in speed distributions when compared to dry conditions. Further, the shift from no-rain to rain showed an increase in time gap and a reduction in speed. No statistically significant differences were observed between following distances in any weather conditions – suggesting that drivers tend to maintain following distance irrespective of weather conditions and speed reduction causes the observed time gap increase. This is supported by the observed 5.6% decrease in mean time gap – from 1.97 s to 2.1 s and the 3.7% decrease in mean speed – from 47 mph (75.6 km/h) to 45.3 mph (72.9 km/h).     

Men appear more lateralized when noticing emotion in male faces

Empirical tests of the "right hemisphere dominance" versus "valence" theories of emotion processing are confounded by known sex differences in lateralization. Moreover, information about the sex of the person posing an emotion might be processed differently by men and women because of an adaptive male bias to notice expressions of threat and vigilance in other male faces. The purpose of this study was to investigate whether sex of poser and emotion displayed influenced lateralization in men and women by analyzing "laterality quotient" scores on a test which depicts vertically split chimeric faces, formed with one half showing a neutral expression and the other half showing an emotional expression. We found that men (N = 50) were significantly more lateralized for emotions indicative of vigilance and threat (happy, sad, angry, and surprised) in male faces relative to female faces and compared to women (N = 44). These data indicate that sex differences in functional cerebral lateralization for facial emotion may be specific to the emotion presented and the sex of face presenting it.