Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase

The concept of acceptance is receiving increased attention as an alternate approach to the suffering that is often associated with persistent and disabling pain. This approach differs from established treatments in that it does not principally focus on reducing pain, but on reducing the distressing and disabling influences of pain as they concern important areas in patients' lives. The present analyses represent a preliminary evaluation of an acceptance-based approach to chronic pain within an interdisciplinary treatment program. One hundred and eight patients with complex chronic pain conditions completed treatment and provided data for the current study. Treatment was conducted in a 3- or 4-week residential or hospital-based format. It included a number of exposure-based, experiential, and other behavior change methods focused on increasing (a) engagement in daily activity regardless of pain and (b) willingness to have pain present without responding to it. Significant improvements in emotional, social, and physical functioning, and healthcare use were demonstrated following treatment. The majority of improvements continued at 3-months post-treatment. Improvements in most outcomes during treatment were correlated with increases in acceptance, supporting the proposed process of treatment.     

Distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed.     

The impact of enhanced incentives on vocational rehabilitation outcomes for dually diagnosed veterans

This study evaluated the efficacy of adding contingency management techniques to vocational rehabilitation (VR) to improve treatment outcome as measured by entry into competitive employment. Nineteen dually diagnosed veterans who entered VR in the Veterans' Administration's compensated work therapy (CWT) program were randomly assigned to CWT (n = 8) or to CWT with enhanced incentives (n = 11). Over the first 16 weeks of rehabilitation, those in the incentives condition could earn up to dollar 1,006 in cash for meeting two sets of clinical goals: (a) remaining abstinent from drugs and alcohol and (b) taking steps to obtain and maintain a competitive job. Results indicate that relative to participants in the CWT-only group, those in the incentives condition engaged in more job-search activities, were more likely to remain abstinent from drugs and alcohol, were more likely to obtain competitive employment, and earned an average of 68% more in wages. These results suggest that rehabilitation outcomes may be enhanced by restructuring traditional work-for-pay contingencies to include direct financial rewards for meeting clinical goals.     

Moral conviction: another contributor to attitude strength or something more?

Attitudes held with strong moral conviction (moral mandates) were predicted to have different interpersonal consequences than strong but nonmoral attitudes. After controlling for indices of attitude strength, the authors explored the unique effect of moral conviction on the degree that people preferred greater social (Studies 1 and 2) and physical (Study 3) distance from attitudinally dissimilar others and the effects of moral conviction on group interaction and decision making in attitudinally homogeneous versus heterogeneous groups (Study 4). Results supported the moral mandate hypothesis: Stronger moral conviction led to (a) greater preferred social and physical distance from attitudinally dissimilar others, (b) intolerance of attitudinally dissimilar others in both intimate (e.g., friend) and distant relationships (e.g., owner of a store one frequents), (c) lower levels of good will and cooperativeness in attitudinally heterogeneous groups, and (d) a greater inability to generate procedural solutions to resolve disagreements.     

Up and down in middle age: monotonic and nonmonotonic changes in roles, status, and personality

It is proposed that personality (conceptualized in terms of motives and psychological resources) changes normatively not only from young adulthood to middle age but also within middle age and that these changes take place in relation to social and biosocial change over the same period. Data from 123 women studied at ages 27, 43, 52, and 61 largely supported hypotheses about change in social roles, status, health, motives, personality characteristics, emotion regulation, and relationships. Noteworthy aspects of the findings were substantial curvilinear change within middle age and associations of work involvement and physical health with personality change during late middle age.     

Gender differences in leg stiffness and stiffness recruitment strategy during two-legged hopping

The authors compared leg stiffness (K(VERT)), muscle activation, and joint movement patterns between 11 men and 10 women during hopping. Physically active and healthy men and women performed continuous 2-legged hopping at their preferred rate and at 3.0 Hz. Compared with men, women demonstrated decreased K(VERT); however, after the authors normalized for body mass, gender differences in K(VERT) were eliminated. In comparison with men, women also demonstrated increased quadriceps and soleus activity, as well as greater quadriceps-to-hamstrings coactivation ratios. There were no significant gender differences for joint movement patterns (p>.05). The relationship between the observed gender differences in muscle recruitment and the increased risk of anterior cruciate ligament injury in women requires further study.     

The Impact of Personality and Religion on Attitudes toward Alcohol among 16–18 Year Olds in Northern Ireland

Background: Previous research demonstrates a negative relationship between attitude toward alcohol and religiosity. However, what is less apparent is if this relationship may, at least in part, be a function of individual differences in personality, as previous research has demonstrated a relationship between certain measures of personality and both attitude toward alcohol and attitude toward religiosity. The aim of the present study was to explore the impact of personality and the relative efficacy of different markers of religiosity in predicting attitude toward alcohol among a sample of 16–18 year olds in Northern Ireland. Method: The Francis Scale of Attitude toward Alcohol (Francis, 1992c. Drug and Alcohol Dependence, 31, 45–50) was administered alongside the Abbreviated Revised Eysenck Personality Questionnaire (Francis, Brown, & Philipchalk, 1992. Personality and Individual Differences, 13(4), 443–449), the Francis Scale of Attitude toward Christianity (Francis & Stubbs, 1987. Personality and Individual Differences, 8, 741–743) and measures of frequency of personal prayer and church attendance among a sample of 243 16- to 18-year-old sixth-form students in Northern Ireland. Results and conclusion: The data demonstrate that a more prohibitive attitude toward alcohol was correlated with lower psychoticism scores (tendermindedness) and a more positive attitude toward Christianity. Multiple-regression analyses confirm the importance of attitude toward religion in predicting individual differences in attitude toward alcohol.     

Surgeons and the Spirit: A Study on the Relationship of Religiosity to Clinical Practice

This study aimed to identify the religious practices and beliefs of surgeons and the relationship between surgeons locus of control and religiosity. Thirty-five surgeons completed a survey that included items from the Duke University Religion Index, the Salesian Center Intrinsic Religiosity Scale for Clinicians, and Rotters Locus of Control Scale. Over 68% of sampled surgeons affirmed that their religious beliefs play a part in their practice, 47% attend religious services at least weekly, and 44% pray daily. There was no correlation between locus of control and religiosity. These results challenge the myth of the egocentric, agnostic surgeon.     

Rate of conditioned reinforcement affects observing rate but not resistance to change

The effects of rate of conditioned reinforcement on the resistance to change of operant behavior have not been examined. In addition, the effects of rate of conditioned reinforcement on the rate of observing have not been adequately examined. In two experiments, a multiple schedule of observing-response procedures was used to examine the effects of rate of conditioned reinforcement on observing rates and resistance to change. In a rich component, observing responses produced a higher frequency of stimuli correlated with alternating periods of random-interval schedule primary reinforcement or extinction. In a lean component, observing responses produced similar schedule-correlated stimuli but at a lower frequency. The rate of primary reinforcement in both components was the same. In Experiment 1, a 4:1 ratio of stimulus production was arranged by the rich and lean components. In Experiment 2, the ratio of stimulus production rates was increased to 6:1. In both experiments, observing rates were higher in the rich component than in the lean component. Disruptions in observing produced by presession feeding, extinction of observing responses, and response-independent food deliveries during intercomponent intervals usually were similar in the rich and lean components. When differences in resistance to change did occur, observing tended to be more resistant to change in the lean component. If resistance to change is accepted as a more appropriate measure of response strength than absolute response rates, then the present results provide no evidence that higher rates of stimuli generally considered to function as conditioned reinforcers engender greater response strength.     

Internal consistency reliability of the Francis Scale of Attitude toward Alcohol among adolescents in Northern Ireland

The Francis Scale of Attitude toward Alcohol was completed by 324 adolescents (M= 17.1 yr., SD=3.6) in Northern Ireland to examine reliability of the measure among this age group. These data support its internal consistency (.89) and suggest that the Francis Scale of Attitude toward Alcohol is psychometrically appropriate for use among this age group.