Reducing emergency medical service use in patients with chronic psychotic disorders: results from the FAST intervention study

Patients with schizophrenia have disproportionately high rates of emergency medical service use, likely contributing to the high cost this illness places on society. The aim of this study was to examine the impact of a theory-based, behavioral intervention on immediate and long-term use of emergency medical services. Older patients with schizophrenia (n=240) were randomized to receive either a behavioral, skills-building intervention known as Functional Adaptation and Skills Training (FAST) or a time-equivalent attention-control condition (AC). Logistic regression analyses indicated that AC participants were nearly twice as likely to use emergency medical services in general (OR=2.54; p=0.02) and emergency psychiatric services in particular (OR=3.69; p=0.05) during the active intervention phase of the study. However, there were no differences between the interventions in terms of emergency service use during the long-term follow-up phase of the study (i.e., 6-18 months post-baseline). The FAST intervention appears efficacious for reducing the short-term risk of using emergency medical services. However, the long-term efficacy of the FAST intervention appears less clear. Future studies may want to provide more powerful maintenance sessions to encourage continued use of skills in patients' real-world settings.     

Making Sense of Abuse: Case Studies in Sibling Incest

This case study focused on the process of making sense of abuse in two Latino families experiencing sibling incest. Participants included five male children ranging in age from 8 to 15 that were members of two families dealing with the issue of sibling incest. The purpose of this study was to build understanding of how families experience sibling incest and its role in their families. Clinical data from therapy sessions was analyzed to reveal that families made sense of the incest in different ways including abuse as normal and abuse as a mistake. Central concepts that explained how the families responded to the sibling incest included (1) level of family cohesion, (2) role of secrecy, and (3) view of outside systems. The findings suggest that treatment needs to include an in-depth assessment regarding these issues.     

Recognizing National Hockey League greatness with an ignorance-based heuristic.

This study examined whether people adhered to the recognition heuristic (i.e., inferred that a recognized hockey player had more total career points than an unrecognized player) and whether using this heuristic could yield accurate decisions. On paired comparisons, having participants report whether they recognized each player plus any knowledge they had about each player permitted players to be classified as either unrecognized (UR), merely recognized (MR), or recognized with additional knowledge (RK), thus producing six possible trial types. Participants adhered to the recognition heuristic on 95% of MR-UR trials and were accurate on 81% of those trials. They chose the recognized player on 98% of RK-UR trials, yielding 94% accuracy. Women had less knowledge and recognized fewer players than men, yet they were nearly as accurate as men. Future research should examine the conditions under which the recognition heuristic is an adaptive strategy.     

Self-efficacy and work-related performance: the integral role of individual differences

The present study estimated the unique contribution of self-efficacy to work-related performance controlling for personality (the Big 5 traits), intelligence or general mental ability, and job or task experience. Results, based on a meta-analysis of the relevant literatures, revealed that overall, across all studies and moderator conditions, the contribution of self-efficacy relative to purportedly more distal variables is relatively small. Within moderator categories, there were several cases in which self-efficacy made unique contributions to work-related performance. For example, self-efficacy predicted performance in jobs or tasks of low complexity but not those of medium or high complexity, and self-efficacy predicted performance for task but not job performance. Overall, results suggest that the predictive validity of self-efficacy is attenuated in the presence of individual differences, though this attenuation does depend on the context.     

Visual and haptic feedback contribute to tuning and online control during object manipulation

The authors employed a virtual environment to investigate how humans use haptic and visual feedback in a simple, rhythmic object-manipulation task. The authors hypothesized that feedback would help participants identify the appropriate resonant frequency and perform online control adjustments. The 1st test was whether sensory feedback is needed at all; the 2nd was whether the motor system combines visual and haptic feedback to improve performance. Task performance was quantified in terms of work performed on the virtual inertia, ability to identify the correct rhythm, and variability of movement. Strict feedforward control was found to be ineffective for this task, even when participants had previous knowledge of the rhythm. Participants (N = 11) performed far better when feedback was available (11 times more work, 2.2 times more precise frequency, 30% less variability; p < .05 for all 3 performance measures). Using sensory feedback, participants were able to rapidly identify 4 different spring-inertia systems without foreknowledge of the corresponding resonant frequencies. They performed over 20% more work with 24% less variability when provided with both visual and haptic feedback than they did with either feedback channel alone (p < .05), providing evidence that they integrated online sensory channels. Whereas feedforward control alone led to poor performance, feedback control led to fast tuning or calibration of control according to the resonant frequency of the object, and to better control of the rhythmic movement itself.     

Specificity of cognitive and behavioral variables to Positive and Negative Affect

The Tripartite Model proposes that a combination of greater Negative Affect (NA) and reduced Positive Affect (PA) contributes to depressive symptoms. The purpose of this study was to test a model of affective experience in which cognitive variables (i.e., negative cognitions and appraisals) are uniquely related to NA but not PA, and in which behavioral variables (i.e., activity participation) are uniquely associated with PA but not NA. Participants included 88 spousal Alzheimer caregivers (mean age = 74 years). Multiple regression models, in which negative cognitions (i.e., helplessness, blames self, and negative appraisals) and activity participation (i.e., frequency of engaging in social and recreational activities) were used to predict depressive symptoms, PA and NA. Results indicated that while helplessness, blaming oneself, negative appraisals, and activity participation all significantly predicted depressive symptoms, only negative cognitive variables significantly predicted NA, and only activity participation significantly predicted PA. These data confirm that depressive experience consists of two relatively independent components - increased Negative Affect and reduced Positive Affect - which have unique correlates in negative cognitions and activity participation. If confirmed, the findings suggest the utility of focusing interventions on each of these components in the management of depressive symptoms.     

Using the MMPI-2 to Predict Symptom Reduction During Psychotherapy in a Sample of Community Outpatients

In the present study, potential MMPI-2 predictors of psychotherapy outcome were examined in a community clinical sample of 51 patients seeking treatment at a university training clinic. Results indicated that particular MMPI-2 scales (L, F, Pd, Pa, Sc, Trt) were the most predictive of initial levels of patient distress, whereas three other clinical scales (Hs, D, Hy) were significantly associated with actual symptom reduction over time. The clinical implications of these data include the use of the MMPI-2 in clinical practice as a means to frame the provision of direct feedback to patients regarding the likelihood of treatment response, which in turn, might actually have therapeutic benefits. The limitations of the study are reviewed and suggestions for future research are offered, including the potential use of widely known and utilized instruments in helping to predict response to psychotherapy.     

EFFECTS OF POINT‐LOSS PUNISHERS ON HUMAN SIGNAL‐DETECTION PERFORMANCE

Three experiments using human participants varied the distribution of point‐gain reinforcers or point‐loss punishers in two‐alternative signal‐detection procedures. Experiment 1 varied the distribution of point‐gain reinforcers for correct responses (Group A) and point‐loss punishers for errors (Group B) across conditions. Response bias varied systematically as a function of the relative reinforcer or punisher frequencies. Experiment 2 arranged two conditions — one where an unequal ratio of reinforcement (5:1 or 1:5) was presented without punishment (R‐only), and another where the same reinforcer ratio was presented with an equal distribution of point‐loss punishers (R+P). Response bias was significantly greater in the R‐only condition than the R+P condition, supporting a subtractive model of punishment. Experiment 3 varied the distribution of point‐gain reinforcers for correct responses across four unequal reinforcer ratios (5:1, 2:1, 1:2, 1:5) both without (R‐only) and with (R+P) an equal distribution of point‐loss punishers for errors. Response bias varied systematically with changes in relative reinforcer frequency for both R‐only and R+P conditions, with 5 out of 8 participants showing increases in sensitivity estimates from R‐only to R+P conditions. Overall, the results indicated that punishers have similar but opposite effects to reinforcers in detection procedures and that combined reinforcer and punisher effects might be better modeled by a subtractive punishment model than an additive punishment model, consistent with research using concurrent‐schedule choice procedures.     

A Primer of the Values Implicit in Counseling Research Methods

The author attempts to answer 5 related questions: What are implicit values? Why are these values often considered problematic to traditional science? Why are such values necessary to research? What are the main values of traditional methods in psychology? What are the implications of a value‐laden science?     

Assessment of Discipline Styles Among Parents of Preschool Through School-Age Children

The Parenting Scale (D.S. Arnold, S.G. O'Leary, L.S. Wolff, & M.M. Acker, 1993) is a self-report measure of parenting practices that has demonstrated sound psychometric properties when used with the parents of young children. However, less is known about the use of this measure with parents of older children. This study was conducted to examine the psychometric properties and factor structure of the Parenting Scale in a normative sample of parents with children 2–12 years old. Findings reveal that the psychometric properties remain strong among the parents of elementary school children, with minimal differences in scores as a function of children's age. However, the data suggest that the factor structure may differ from that proposed by the authors. Although statistically significant correlations with ADHD symptoms were revealed, the magnitude of these correlations was relatively small. Suggestions for future research and clinical use of this scale are discussed.