Testing Clinical Intuitions About Barriers to Improvement in Cognitive-Behavioral Therapy for Panic Disorder

Although clinical intuitions influence psychotherapeutic practice and are a rich source of novel hypotheses for research, many remain to be empirically tested. This study evaluates whether clinicians’ beliefs about barriers to progress in cognitive-behavioral therapy (CBT) for panic disorder are supported by data. Data from a randomized-controlled trial comparing CBT to panic-focused psychodynamic psychotherapy (PFPP) for adults with primary panic disorder (N = 161) were used to evaluate 15 factors endorsed by clinicians as impediments to CBT in a recent survey. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Hierarchical linear modeling revealed that none of the perceived barriers were predictive of poor outcome. Contrary to clinicians’ intuitions, dissociation during panic attacks was associated with greater symptomatic improvement in both treatment arms (β = ?0.69, p < .05), above the effect of established predictors. Moderation analyses revealed that when patients had PTSD diagnosed with the Anxiety Disorders Interview Schedule (β = 1.71, p < .05) or less severe panic disorder (β = 0.45, p = .04), they changed more rapidly in CBT than in PFPP. Overall, clinician agreement was inversely related to the strength of a predictor (r = ?.24, p = .39). Although clinical intuitions can be useful as clinical and empirical signals, such beliefs should be critically examined before informing practice. Dialogue between academics and clinicians might be enhanced through research that incorporates input from front-line practitioners.     

Psychosocial wellbeing in the Central and Eastern European transition: An overview and systematic bibliographic review

This paper presents the results of a systematic review of literature on the psychosocial wellbeing of populations in Central and Eastern Europe during the transition period subsequent to the fall of the Soviet Bloc. A revision of research addressing emotional wellbeing trends in this period and theoretical models was carried in order to verify their validity in the analysis of empirical studies. Hence, a systematic bibliographic review was conducted, aiming to find possible subjective mediators between social variables derived from changes and emotional wellbeing. The results of the review show that subjective mediators such as locus of control, perceived control, self‐efficacy beliefs, perceived familial support, and the subjective evaluation of social change explain part of the relationship between macrosocial changes and emotional wellbeing. Results appear coherent with proposed multidimensional models of social change and mental health, although further research should be conducted to determine the specific weight of these phenomena in individual emotional wellbeing.     

Contents: Volume 29

This paper describes our experience in treating nearly 200 eating disordered patients ages eleven to thirty-five in five ongoing, open groups combining inpatients and outpatients. A limited outcome study of 121 patients who attended group regularly is presented. Guidelines are offered for group formation, referral to group, function of the therapists, group themes, and management of specific problems arising during the group. Our experience suggests broader applicability of group treatment for eating disorders than previously reported. The age and developmental level of the patient is a more important consideration in group placement than the nature or severity of their eating disorder. More vigorous and longer term follow-up studies are necessary to determine the lasting benefits of group psychotherapy for this patient population.     

How Outgroup Salespeople Fit in or Fail to Fit in: A Proposed Acculturation Effects Framework

The findings of several research studies suggest that gender, culture, and ethnic group are associated reliably with differences in workplace behaviors. This paper looks beyond demographic differences to a broader concept of group-based differences and addresses how differences in the behavioral reactions of outgroup sales trainees affect sales managers' attempts to socialize them into the organization. It is important for sales managers to be able to understand how differences are related to workplace behavior as sales forces become increasingly diverse. A framework and research propositions are offered based on theories of socialization, acculturation, and person—organization fit. In addition, interviews were conducted with salespeople to assess the viability of the proposed framework. Several areas of future research emerge as a result of this exploratory discussion.     

Examining the Development of Attention and Executive Functions in Children With a Novel Paradigm

The development of attention and executive functions in normal children (7–12 years) was investigated using a novel selective reaching task, which involved reaching as rapidly as possible towards a target, while at times having to ignore a distractor. The information processing paradigm allowed the measurement of various distinct dimensions of behaviour within a single task. The largest improvements in vigilance, set-shifting, response inhibition, selective attention, and impulsive responding were observed to occur between the ages of 8 and 10, with a plateau in performance between 10 and 12 years of age. These findings, consistent with a step-wise model of development, coincide with the observed developmental spurt in frontal brain functions between 7 and 10 years of age, and indicate that attention and executive functions develop in parallel. This task appears to be a useful research tool in the assessment of attention and executive functions, within a single task. Thus it may have a role in determining which cognitive functions are most affected in different childhood disorders.     

Limitations in Verbal Fluency Following Heavy Burdens of Early Childhood Diarrhea in Brazilian Shantytown Children

The effects of heavy burdens of diarrhea in the first 2 years of life on specific executive control function like verbal fluency are not well understood. In previous studies, we have shown associations of early childhood diarrhea (ECD) with nonverbal intelligence and school functioning. Therefore, we postulated that ECD might affect early neuropsychological development leading to long-term deficits in normal cognitive development. Based on our extensive 14-year prospective cohort studies of early childhood diarrheal illnesses in a Brazilian shantytown community, we examined ECD correlations between specific impairments of higher mental function and executive skills in shantytown children 5–10 years later (now at 6–12) years of age. Specifically we examined whether heavy diarrheal illnesses correlate with reduced performance on selected tests of executive function. Our study, for the first time, suggests a disproportional impairment in semantic but not phonetic fluency in a subset of children with heavy burdens of diarrhea in their first 2 years of life even when controlling for maternal education, breastfeeding, and child schooling. Similar semantic decrements have been associated with impaired recovery from brain injury. These exploratory studies suggest the importance of verbal fluency tests to assess executive functioning in children challenged by poor nutrition and diarrhea in early life. In addition, our unique findings show the potential influences of early childhood diarrhea on language development that is so critical to productive adulthood and potentially set a foundation for new neuropsychological approaches, which assess early burdens of enteric illnesses on childhood development.     

Gender Mainstreaming and Healthcare Policy

This review addresses how The Palgrave Handbook of Gender and Healthcare structures and analyzes the themes that emerge from its own interrogation of the complex concepts of gender, equality, health and policy. Overall the review takes a complimentary tone towards the handbook's arguments and premises and the unique research that sets it apart from other more scientifically or development based gender health texts. It points out, however, that the book maintains its focus on the global north and the efficacy of state policy as the primary tool for gender equality, however defined. The author suggests that in future discussions, the alternative routes and different countries that are only just touched on in the text should be more thoroughly explored.     

Social Psychological Benefits of Gay Games Participation: A Social Identity Theory Explanation

Abstract

Research examining sexual orientation in sport settings has been limited in scope and lacked theoretical frameworks. To extend this body of research, the current study was framed within social identity theory and examined the impact of Gay Games participation on: (a) social identity, self-esteem, and collective esteem; and (b) expected subsequent social change activities following the Games. One hundred and twenty-five lesbian and bisexual athletes competing in Gay Games V participated in this investigation. The athletes completed a demographic profile and an open-ended questionnaire that asked about their Gay Games experience as well as expected social change activities after the Games. A content analysis of the responses revealed themes consistent with social identity theory. Specifically, these individuals identified the role of the Gay Games on social categorization, personal and social identity, and self and collective esteem. Additionally, these women revealed that following the Gay Games they felt more likely to work towards social change by becoming more out, educating others, and working through political channels.     

Using the Scenario Method to Analyze Cheating Behaviors

Using student self-reported cheating admissions and answers from a hypothetical cheating scenario, this paper analyzes the effects of individual and situational factors on potential cheating behavior. Results confirm several conclusions about student factors that are related to cheating. The probability of cheating is associated with younger students, lower GPAs, alcohol consumption, fraternity/sorority membership, and having cheated in high school. Student perceptions of the certainty and severity of punishment appear to have a negative and significant impact on the probability of cheating on in-class assignments. Students who report a belief that cheating is never acceptable appear to be significantly less likely to cheat in any circumstance. This study illustrates the context-dependent nature of academic dishonesty, and the associated difficulty in understanding the relationships between measurable factors and cheating behavior.