Information giving and involvement in treatment decisions: Is more really better? Psychological effects and relation with adherence

Objectives : The aim of this study is to improve our understanding of the ways in which a medical consultation style relates to satisfaction and adherence.

Design : Participants completed questionnaires about preferred and perceived consultation styles; psychological variables such as satisfaction, anxiety and depression; and questions about taking medication. Questionnaires were completed prior to the consultation, immediately after, three months later and one year later. Doctors also completed a scale on completion of the consultation. The decisions in question related to women seeking advice about Hormone Replacement Therapy (HRT) and decisions about pain management.

Results : Patients expressed preferences for information about the treatment options and for active involvement in the decision process. The extent to which patients perceived themselves as having received information about the treatment options was a particularly consistent predictor of satisfaction. The extent to which patients perceived themselves as having been prepared for the side effects of HRT was a consistent predictor of anxiety.

Conclusions : Perceptions of the amount of information received about medical options, including information preparing individuals for potential side effects of medication, appears to be more important to satisfaction and anxiety, than actual involvement in the decision.     

A Preliminary Evaluation of Functional Communication Training Effectiveness and Language Preference When Spanish and English are Manipulated

We evaluated whether differences in treatment effectiveness or preference between languages emerged across Spanish and English during functional communication training (FCT) for young children with developmental disabilities exposed to Spanish and English in the home environment. Participants were 2 young children with developmental disabilities who displayed destructive behavior maintained by social contingencies and whose families spoke Spanish and English at home. All procedures were conducted in the participants’ homes by their mothers with coaching from the investigator. The effectiveness of FCT was evaluated within a reversal design across baseline, FCT, and extinction conditions. A multielement design across language type (Spanish and English) was embedded within the reversal design during the extinction and FCT conditions to evaluate differences in treatment effectiveness across type of language. Finally, during all FCT sessions, a concurrent schedules design was used to evaluate participant preference for type of language. Results suggested that FCT was effective in reducing destructive behavior, increasing manding, and/or increasing task completion for these 2 participants across Spanish and English treatment conditions. Preference for the type of language did not emerge for either participant during FCT. Results are discussed in terms of the merits of systematically evaluating language variables when working with culturally and linguistically diverse families and children.     

Nonaddictive instrumental drug use: Theoretical strengths and weaknesses

The potential to instrumentalize drug use based upon the detection of very many different drug states undoubtedly exists, and such states may play a role in psychiatric and many other drug uses. Nevertheless, nonaddictive drug use is potentially more parsimoniously explained in terms of sensation seeking/impulsivity and drug expectations. Cultural factors also play a major role in nonaddictive drug use.     

The enduring impact of borderline personality pathology: risk for threatening life events in later middle-age

Both neuroticism and borderline personality disorder (BPD) are associated with increased frequency of stressful life events in young adults. It is not clear, however, whether this effect extends to later life because BPD is apparently diminished in frequency and severity when people reach middle adulthood. This issue was examined in a representative, community sample of men and women between the ages of 55 and 64 (N = 1,234). Ten DSM-IV PDs and neuroticism were assessed at baseline using a semistructured interview (SIDP-IV) and questionnaire (NEO-PI-R). Life events were measured 6 months later with a self-report questionnaire (LTE-Q) followed by a telephone interview. BPD features and neuroticism predicted increased frequency of life events, based on both self and interviewer-adjusted reports of negative life events. Avoidant and paranoid PD features predicted decreased frequency of negative life events. Approximately 42% of events reported on the LTE-Q were discounted following the telephone interview; higher scores on BPD symptoms were associated with more adjustments to self-report of threatening experiences. These findings indicate that symptoms of BPD and neuroticism continue to have a harmful impact on the lives of older adults.     

Narcissism in Midlife: Longitudinal Changes in and Correlates of Women's Narcissistic Personality Traits

We examined changes in and correlates of 3 kinds of narcissism-hypersensitivity, willfulness, and autonomy-during middle adulthood. Few studies have examined narcissistic personality traits beyond young adulthood, and none has assessed longitudinal changes in narcissism during midlife. In a sample of 70 college-educated women, we found that observer ratings of hypersensitive narcissism were associated with more negative outcomes at ages 43 and 53 (i.e., more depressive symptoms and physical health problems, lower life satisfaction and well-being). Ratings of willfulness and autonomy predicted more positive outcomes. All 3 kinds of narcissism showed considerable rank-order stability over 10 years, but there were also mean-level changes: Hypersensitivity and autonomy decreased, whereas willfulness increased. More positive outcomes were associated with decreases in hypersensitivity and increases in willfulness and autonomy. However, in multivariate analyses, autonomy did not show any significant associations with women's health and well-being outcomes, suggesting that it may have less predictive utility compared to hypersensitivity and willfulness. Our findings highlight developmental changes in and correlates of women's narcissistic personality traits and the importance of assessing different aspects of narcissism in midlife.     

Sustaining the Utilization and High Quality Implementation of Tested and Effective Prevention Programs Using the Communities That Care Prevention System

This paper describes the extent to which communities implementing the Communities That Care (CTC) prevention system adopt, replicate with fidelity, and sustain programs shown to be effective in reducing adolescent drug use, delinquency, and other problem behaviors. Data were collected from directors of community‐based agencies and coalitions, school principals, service providers, and teachers, all of whom participated in a randomized, controlled evaluation of CTC in 24 communities. The results indicated significantly increased use and sustainability of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, during the active phase of the research project when training, technical assistance, and funding were provided to intervention sites, and 2 years following provision of such resources. At both time points, intervention communities also delivered prevention services to a significantly greater number of children and parents. The quality of implementation was high in both conditions, with only one significant difference: CTC sites were significantly more likely than control sites to monitor the quality of implementation during the sustainability phase of the project.     

Commitment to change from locomotion motivation during deliberation

The factors that motivate commitment to behavioral change (e.g., quitting smoking) are important in understanding self-regulation processes. The current research examines how an individual??s motivational orientation during deliberation affects the likelihood that they will commit to change. Building on the insights of regulatory mode theory (Higgins et al. in Advances in experimental social psychology. Academic Press, New York, vol 35, pp 293?C344, 2003), we propose that increased commitment to change can result from increased locomotion motivation in the deliberation phase. Three studies provide evidence that increased commitment to change is related to locomotion motivation arising either from a chronic orientation or from a movement-focused deliberation tactic that intensifies that orientation. Although locomotion motivation is typically associated with goal pursuit, the current work highlights the impact that locomotion motivation can have on commitment to change in the initial deliberation phase.     

Source expertise and persuasion: the effects of perceived opposition or support on message scrutiny

Compared to nonexperts, expert sources have been considered to elicit more processing of persuasive messages because of expectations that the information is likely to be valid or accurate. However, depending on the position of an advocacy, source expertise could activate other motives that may produce a very different relation from that found in past research. When messages are counterattitudinal (disagreeable), experts should motivate greater processing than nonexpert sources because of expectations that they will likely provide robust opposition to one's existing views. In contrast, when advocacies are proattitudinal (agreeable), nonexpert rather than expert sources should elicit more scrutiny because of perceptions that they will likely provide inadequate support to recipients' current views. Two studies offer evidence consistent with these predictions. Manipulations of source expertise created different expectations regarding the strength of opposition or support, and these perceptions accounted for effects of source expertise on the amount of message scrutiny.     

Contrast polarity preservation's role in perception: explained and unexplained stimuli

Roncato and Casco (2003, Perception & psychophysics 65 1252-1272) had shown that in situations where the Gestalt principle of good continuity is put into conflict with preservation of contrast polarity (CP) the perception that preserves CP prevails. Parlangeli and Roncato (2010, Perception 39 255-259) have studied this question of preservation of CP more closely and have added an addendum to the rule. They have used stimuli consisting of a checkerboard of perpendicularly arranged rectangular bricks (white, gray, or black) and draughtsmen white, gray, or black disks placed at the corners of the bricks. This study has caused them to add an addendum to the rule of CP-preserved path-conjunction binding: if there are two contour completions that preserve the CP, the one with the higher contrast will prevail. Parlangeli and Roncato find that, for certain shades of the disks and bricks, the perpendicular lines of the checkerboard appear strikingly to be slanted or undulating. Here we consider all possible arrangements of relative magnitudes of checkerboards consisting of bricks of two different shades and disks of two shades as well, as such arrangements with widely varying differences in the magnitude of brightness. We have found a number of cases where the perception is not explained by the rule and addendum of Roncato and Casco, and Parlangeli and Roncato, and a case where preservation of "distant" as well as local CP plays a role in perception. The previously known cases, and the new exceptional unexplained stimuli we have found, warrant further study.     

THE CLIMATE FOR WOMEN IN ACADEMIC SCIENCE: THE GOOD, THE BAD, AND THE CHANGEABLE

Deficits theory posits that women scientists have not yet achieved parity with men scientists because of structural aspects of the scientific environment that provide them with fewer opportunities and more obstacles than men. The current study of 208 faculty women scientists tested this theory by examining the effect of personal negative experiences and perceptions of the workplace climate on job satisfaction, felt influence, and productivity. Hierarchical multiple regression results indicated that women scientists experiencing more sexual harassment and gender discrimination reported poorer job outcomes. Additionally, perceptions of a generally positive, nonsexist climate, as well as effective leadership, were related to positive job outcomes after controlling for harassment and discrimination. We discuss implications for the retention and career success of women in academic science.