Pragmatic trials testing the effectiveness of interventions under “real world” conditions help bridge the research-to-practice gap. Such trial designs are optimal for studying the impact of implementation efforts, such as the effectiveness of integrated behavioral health clinicians in primary care settings. Formal pragmatic trials conducted in integrated primary care settings are uncommon, making it difficult for researchers to anticipate the potential pitfalls associated with balancing scientific rigor with the demands of routine clinical practice. This paper is based on our experience conducting the first phase of a large, multisite, pragmatic clinical trial evaluating the implementation and effectiveness of behavioral health consultants treating patients with chronic pain using a manualized intervention, brief cognitive behavioral therapy for chronic pain (BCBT-CP). The paper highlights key choice points using the PRagmatic-Explanatory Continuum Indicator Summary (PRECIS-2) tool. We discuss the dilemmas of pragmatic research that we faced and offer recommendations for aspiring integrated primary care pragmatic trialists.
Previous studies suggest that those who naturally vary their pronoun use over the course of expressive writing subsequently report the greatest improvements in physical and mental health. To explore possible perspective taking or perspective switching effects, two studies manipulated writing perspectives about emotional events from either a first-person, second-person, or third-person perspective. In Study 1, 55 students were randomly assigned to one of the three writing perspectives and were asked to write from the same perspective for three 5-minute writing sessions. In Study 2, 129 students wrote for three 5-minute sessions, one from each perspective in a counterbalanced order. The results showed that writing from a first-person perspective conferred more perceived benefits and was associated with using more cognitive mechanism words, whether engaged in perspective taking or perspective switching. 相似文献
ABSTRACTAnxious individuals report disproportionately negative expectations concerning the future, termed the negative expectancy bias. In contrast, ageing is associated with an inflated expectancy for positive future events. A recent study [Steinman, S. A., Smyth, F. L., Bucks, R. S., MacLeod, C., &; Teachman, B. A. (2013). Anxiety-linked expectancy bias across the adult lifespan. Cognition and Emotion, 27, 345–355. doi:10.1080/02699931.2012.711743] found using an interpretation bias task, a negative expectancy bias in young adults and positive expectancy bias in older adults with high trait anxiety. Extending this, the current study examined expectancy bias for positive, negative and ambiguously emotionally toned information in younger and older adults with clinical levels of depression and anxiety to community control groups, thus allowing examination of both disorder status and age on biases. Clinical participants reported a pervasive tendency to expect negative events relative to positive regardless of whether the current scenarios were positive, negative or ambiguous. Older adults showed greater expectancy for future positive scenarios when the initial scenario was negative or ambiguous. Age moderated the negative expectancy bias shown by clinical participants for ambiguous scenarios. Clinical disorders in older adults attenuated the positive expectancy bias that was otherwise strong in community participants. These findings provide further evidence for age differences in processing of emotionally toned information, with older adults showing a greater expectancy for positive future events. 相似文献
The cross-race effect (CRE) is the tendency to have better recognition accuracy for same-race than for other-race faces due to differential encoding strategies. Research exploring the nature of encoding differences has yielded few definitive conclusions. The present experiments explored this issue using an eyetracker during a recognition task involving White participants viewing White and African American faces. Participants fixated faster and longer on the upper features of White faces and the lower features of African American faces. When instructing participants to attend to certain features in African American faces, this pattern was exaggerated. Gaze patterns were related to improved recognition accuracy. 相似文献
Task switching research has so far focused on the impact of switching task-sets between two-choice classification tasks that require little or no memory load. Empirical work is lacking however to determine whether the switching cost can be extended to other cognitive activities and to different types of switches. In the present study, switching between the content – verbal to spatial – of the tasks was contrasted with switching cognitive processes — categorization to serial memory. Our pattern of results revealed the absence of local and general switch costs on serial memory tasks, while substantial costs were observed with two-choice judgement tasks. Such a finding challenges the widely accepted assumption that task alternation comes with a considerable cost in performance regardless of the cognitive tasks undertaken. Our results are discussed in context of the predominant models of task switching. 相似文献
Early adolescence is marked by transitions for adolescents, and is also a time for identity exploration. Ethnic identity is an essential component of youths' sense of self. In this study we examined the trajectories of ethnic identity for adolescents from ethnic minority backgrounds during a 4-year period. Six latent class trajectories were identified in the study: the majority of adolescents (41.8%) displayed growth in ethnic identity over 4 years, followed by 30.1% whose high levels of ethnic identity remained stable, then by those who experienced moderate decreases in ethnic identity (10.8%). Another class of adolescents (7.3%) showed significant declines in ethnic identity level, followed by 5.5% of adolescents with significant increases, and finally by 4.5% of adolescents with low stable levels of ethnic identity during this developmental period. The classes differed by ethnicity, and adolescents with increasing high levels of ethnic identity reported better parent-child relationships. Findings and implications are discussed. 相似文献
This study investigated the effects of nonverbal self‐disclosure within the dynamic of aptitude—treatment interaction. Participants (N= 94) watched a video of a career counseling session aimed at helping the jobseeker to find employment. The video was then edited to display 3 varying degrees of nonverbal self‐disclosure. In conjunction with the measure of counselor assessment, the authors measured the fear‐of‐intimacy level by using the Doi and Thelen (1993) model. Results showed that when self‐disclosure does not have an effect on counselor assessment, a moderator effect due to the fear of intimacy becomes evident. Implications for research and practice are presented. 相似文献
New learning often interferes with the production of older, previously learned responses. However, the original responses usually appear to spontaneously recover and regain their dominance after a delay. This article takes a new approach to questions of interference and recovery by examining performance on immediate and delayed tests using direct or indirect instructions. Direct instructions asked participants to deliberately retrieve the original responses, and indirect instructions allowed them to respond on a more automatic basis, using whatever response came to mind first. Results suggest that interference and recovery may have their largest effects via relatively automatic influences on memory, such as the accessibility of new versus original information. This finding adds a new perspective to classic theories of interference and recovery, and may also inform current understanding of performance in populations (e.g., older adults) that often rely predominantly on automatic memory processing. 相似文献