Is it the symptom or the relation to it? Investigating potential mediators of change in acceptance and commitment therapy for psychosis

Cognitive and behavioral interventions have been shown to be efficacious when used as an adjunct to pharmacotherapy for psychotic disorders. However, little previous research has investigated potential mediators of change in psychological treatments for psychosis. Acceptance and mindfulness-based therapies do not focus on directly reducing the psychotic symptoms themselves, but instead attempt to alter the patient's relationship to symptoms to decrease their negative impact. The current study examined this issue with data from a previously published randomized trial comparing brief treatment with Acceptance and Commitment Therapy (ACT) versus treatment as usual for hospitalized patients with psychotic symptoms (Gaudiano & Herbert, 2006a). Results showed that the believability of hallucinations at posttreatment statistically mediated the effect of treatment condition on hallucination-related distress. Hallucination frequency did not mediate outcome. The current study is a first step toward understanding the potential mechanisms of action in psychological treatments for psychosis.     

Secondary smoking prevention in a university setting: a randomized comparison of an experiential, theory-based intervention and a standard didactic intervention for increasing cessation motivation.

OBJECTIVE: College may represent an untapped opportunity to reach the growing number of student smokers who are at risk of progressing toward regular smoking. The aim of this study was to test the efficacy of a theory-based experiential intervention for increasing motivation to quit smoking and reducing smoking behavior. DESIGN: This study used a 3-arm, randomized design to examine the efficacy of an experiential secondary prevention intervention. The control groups included a traditional didactic smoking intervention and an experiential intervention on nutrition. MAIN OUTCOME MEASURES: The 2 primary dependent variables were change in self-reported intention to quit smoking, measured pre- and postintervention, and change in smoking behavior over the month following the intervention. RESULTS: As hypothesized, the experiential smoking intervention was more effective than either control group in increasing immediate motivation to quit, but the effect was found only among female participants. At 1-month follow-up, both smoking interventions produced higher rates of smoking cessation and reduction than did the nutrition control condition. CONCLUSION: Findings support the potential efficacy of an intensive experiential intervention for female smokers.     

High-Risk Palliative Care Patients’ Knowledge and Attitudes about Hereditary Cancer Testing and DNA Banking

Even at the end of life, testing cancer patients for inherited susceptibility may provide life-saving information to their relatives. Prior research suggests palliative care inpatients have suboptimal understanding of genetic importance, and testing may be underutilized in this clinical setting. These conclusions are based on limited research. This study aimed to estimate genetic testing prevalence among high-risk palliative care patients in a National Cancer Institute-designated comprehensive cancer center. We also aimed to understand these patients’ understanding of, and attitudes toward, hereditary cancer testing and DNA banking. Palliative care in-patients with cancer completed structured interviews, and their medical records were reviewed. Among patients at high risk for hereditary cancer, we assessed history of genetic testing/DNA banking; and related knowledge and attitudes. Among 24 high-risk patients, 14 (58.3%) said they/their relatives had genetic testing or they had been referred for a genetics consultation. Of the remaining 10 patients, seven (70%) said they would “probably” or “definitely” get tested. Patients who had not had testing were least concerned about the impact of future testing on their family relationships; two (20%) said they were “extremely concerned” about privacy related to genetic testing. Of patients without prior testing, five (50%) said they had heard or read “a fair amount” about genetic testing. No high-risk patients had banked DNA. Overall, 23 (95.8%) said they had heard or read “almost nothing” or “relatively little” about DNA banking. Written materials and clinician discussion were most preferred ways to learn about genetic testing and DNA banking. Overall, this study demonstrates underutilization of genetics services at the end of life continues to be problematic, despite high patient interest.     

Review and Comparison of Electronic Patient-Facing Family Health History Tools

Family health history (FHx) is one of the most important pieces of information available to help genetic counselors and other clinicians identify risk and prevent disease. Unfortunately, the collection of FHx from patients is often too time consuming to be done during a clinical visit. Fortunately, there are many electronic FHx tools designed to help patients gather and organize their own FHx information prior to a clinic visit. We conducted a review and analysis of electronic FHx tools to better understand what tools are available, to compare and contrast to each other, to highlight features of various tools, and to provide a foundation for future evaluation and comparisons across FHx tools. Through our analysis, we included and abstracted 17 patient-facing electronic FHx tools and explored these tools around four axes: organization information, family history collection and display, clinical data collected, and clinical workflow integration. We found a large number of differences among FHx tools, with no two the same. This paper provides a useful review for health care providers, researchers, and patient advocates interested in understanding the differences among the available patient-facing electronic FHx tools.     

Measuring Community Integration of Lusophone West African Immigrant Populations Through Needs Assessment,Human Security,and Realistic Conflict Theory

This article describes the process of developing and validating an immigrant community integration factor score from three different indicators based on three theories: human security, needs assessment, and realistic conflict. Over twenty days in May/June of 2015, fifty-seven semi-structured interviews were conducted with Bissau-Guinean immigrants on Boa Vista and Santiago Islands of Cabo Verde in West Africa to pilot test this instrument. Questions asked measured study participants’ needs assessment, human security levels, and conflict experiences. These findings demonstrate the applicability of combining these three indicators into an aggregate integration score, validated through confirmatory factor analysis using partial least squares path modeling. This article shows how the immigrant community integration factor score accounts for the situational context, in this case, increasing population and resource pressures leading to tension, conflict, and outbursts of violence before various institutional and policy interventions calmed the situation. While this study serves as a test case, we are confident that the validated integration score can serve as an effective proxy for measuring the level of comprehensive community integration not along individual acculturation indices, but according to broader human security and conflict potential at the community level.     

Episodic Life Stress and the Development of Overgeneral Autobiographical Memory to Positive Cues in Youth

Overgeneral autobiographical memory (OGM) has been established as a risk factor for depression in both youth and adults, but questions remain as to how OGM develops. Although theorists have proposed that the experience of stressful life events may contribute to the development of OGM, no studies have examined the impact of negative life events on prospective changes in OGM. The goal of the current study was to address this gap in the literature. Participants included 251 mothers and their biological children (aged 8–14 years old at the initial assessment). Using a multi-wave prospective design with assessments every 6 months for 2 years, we found that episodic life stress predicted prospective decreases in youths’ autobiographical memory specificity to positive, but not negative, cues. This study supports theories proposing that negative life events may contribute to the development of OGM, but suggest that, in youth, the impact of life stress on OGM may be specific to positive rather than negative memories.     

Economic implications of access to daylight and views in office buildings from improved productivity

Previous research has found significant impacts of daylight and views on the cognitive function of office workers. In this study, we use scores on decision-making performance to estimate the annual economic potential of optimizing daylighting and views in U.S. offices. Cognitive scores were compared against over 100,000 previous test scores to obtain the distributional shift in cognitive performance when working in an office with optimized daylighting and views as opposed to an office with traditional blinds. These changes in performance were then compared to compensation data from the Bureau of Labor Statistics. Office workers shifted on average from the 52nd percentile to 65th percentile, equivalent to a $11,809 difference in salary per person per year. When conservatively accounting for the number of employees working within 15 ft of a window with blinds, optimizing daylight and views in U.S. offices has the potential to generate $352B ($240B–$464B), or 1.7% of the 2018 U.S. gross domestic product (GDP), in additional productivity. These findings suggest that building developers, architects and tenants should give additional attention to daylight design and façade technology as they consider new building construction, renovation and leasing options.