Prospective Study of Major Loss Life Events and Risk for Suicidal Thoughts and Behaviors Among Adolescents and Young Adults

This prospective, naturalistic study examined the association between major loss life experiences, other psychiatric risk factors (depression, hopelessness, and anxiety), and suicidal thoughts and behaviors (STBs) among adolescents followed through young adulthood for up to 14 years. Major loss life events were related to subsequent increases in STBs. Major loss life events were primarily related to increases in suicide ideation in the presence of lower levels of other risk factors. There was a bidirectional relationship between major losses and other risk factors. Implications for the association between loss experiences, other risk factors, and future STBs are discussed.     

A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

"Shhh! We're tryin' to concentrate": attention and environmental distracters in novel word learning

The authors' purpose in this study was to evaluate the role of attention, as a central dimension of temperament, in children's real-time acquisition of novel vocabulary. Environmental distractions were administered to 47 22-month-old children as they acquired novel vocabulary in a fast-mapping task. Two distraction conditions impeded novel word acquisition, but only 1 impeded attention allocation. Attention allocation was correlated with novel word acquisition under conditions of distraction, but not in their absence. Results suggest that attention allocation is especially important for word learning under conditions of distraction. Given that in their day-to-day lives children often encounter new words amid a host of environmental distractions, children with constitutionally fewer attentional resources, such as temperamentally difficult children, may be at a vocabulary-learning disadvantage.     

Challenges using motivational interviewing as an adjunct to exposure therapy for obsessive-compulsive disorder

Exposure and response prevention (EX/RP) is an efficacious treatment for obsessive-compulsive disorder (OCD). However, patients often do not adhere fully to EX/RP procedures. Motivational interviewing (MI) has been shown to improve treatment adherence in other disorders. This pilot study used a randomized controlled design to examine whether MI can be successfully added to EX/RP and whether this intervention (EX/RP + MI) could improve patient adherence to between-session EX/RP procedures relative to EX/RP alone. Thirty adults with OCD were randomized to 18 sessions of EX/RP or EX/RP + MI. Therapists rated patient adherence at each exposure session. Independent evaluators assessed change in OCD and depressive symptoms, and patients completed self-report measures of readiness for change and quality of life. The two treatment conditions differed in degree of congruence with MI but not in conduct of EX/RP procedures. Both groups experienced clinically significant improvement in OCD symptoms, without significant group differences in patient adherence. There are several possible reasons why EX/RP + MI had no effect on patient adherence compared to standard EX/RP, each of which has important implications for the design of future MI studies in OCD. We recommend that MI be further evaluated in OCD by exploring alternative modes of delivery and by focusing on patients less ready for change than the current sample.     

The functions of nonsuicidal self-injury: support for cognitive-affective regulation and opponent processes from a novel psychophysiological paradigm

Although research on the reasons for engaging in nonsuicidal self-injury (NSSI) has increased dramatically in the last few years, there are still many aspects of this pernicious behavior that are not well understood. The purpose of this study was to address these gaps in the literature, with a particular focus on investigating whether NSSI (a) regulates affective valence in addition to affective arousal and (b) serves a cognitive regulation function in addition to an affect regulation function. To elucidate these issues, the present study utilized a sample of 112 participants (33 controls, 39 no pain controls, 16 NSSI individuals, and 24 controls matching the affect dysregulation levels of the NSSI group), employed psychophysiological measures of affective valence (startle-alone reactivity) and quality of information processing (prepulse inhibition), and used experimental methods involving an NSSI-proxy to model the NSSI process. Results largely were consistent with predictions, supporting the hypotheses that NSSI serves to regulate cognitive processing and affective valence. On this latter point, however, the control groups also showed a decrease in negative affective valence after the NSSI-proxy. This unexpected finding is consistent with the hypothesis that opponent processes may contribute to the development of self-injurious behaviors (Joiner, 2005). Overall, the present study represents an important extension of previous laboratory NSSI studies and provides a fertile foundation for future studies aimed at understanding why people engage in NSSI.     

Tenderness and Steadiness: Relating Job and Interpersonal Demands and Resources With Burnout and Physical Symptoms of Stress in Canadian Physicians

This study examined the extent to which job and interpersonal demands and resources are associated with burnout and physical symptoms of stress among Canadian physicians. Using the job demands‐resources (JD‐R) model, we predicted that demands would be more strongly related to emotional exhaustion and physical symptoms, whereas resources would be more strongly related to personal accomplishment and decreased depersonalization. The findings reveal that communication skills and emotional labor contributed to the explained variances beyond workload and work–life conflict (as job demands), as well as autonomy, predictability, and understanding (as job resources). The predictors were differentially associated with the outcome variables in a manner that is consistent with the JD‐R model. Implications for physician well‐being and improved patient outcomes are discussed.     

Prospective memory: The relative effects of encoding,retrieval, and the match between encoding and retrieval

Previous prospective memory studies have revealed some important features of encoding, retrieval, and the match between the encoding and the retrieval that contribute to prospective memory performance. However, these studies have not provided evidence concerning the relative importance of these three factors because no study has investigated all three in a single design. We developed a laboratory-based paradigm that allowed us to manipulate different characteristics of encoding, retrieval, and the match between encoding and retrieval simultaneously in a single experiment. The results of eight experiments showed that all three factors have an influence on prospective memory performance, but that the match between encoding and retrieval has a significantly larger influence than either encoding or retrieval factors.