Predicting the Outcome of Treatment

The clinical question—“Which treatment(s) for which patients with what set of subgrouping characteristics working by what mechanism(s)?”—rests at the heart of differential therapeutics. Experimentally, this question reduces to a test of how well we can predict the outcome of treatment using the treatment conditions plus other moderating and mediating variables. Reflecting the discussions held at a recent National Institute of Mental Health (NIMH) conference on psychosocial treatments, and using pediatric anxiety disorders as a case in point, we discuss the problem of prediction in treatment outcome studies from the standpoint of definition of terms, using the general linear model of prediction. We also outline types of studies that may be useful in testing potential predictors, and put forward a possible matrix of predictor variables as currently implemented in an NIMH-funded treatment outcome study of pediatric obsessive-compulsive disorder (OCD). We conclude by making specific suggestions for implementing a broader approach to the study of predictors.     

Tools for Assessing Readability and Quality of Health-Related Web Sites

With the Internet becoming a growing source of information on genetics, genetic counselors and other health-care providers may be called upon to guide their patients to appropriate material, which is written at a suitable reading level for the individual and contains quality information. Given that many health-related Web sites are written at a high school or higher reading level, without direction from a genetic counselor or health-care provider, many Internet users may currently be turning to health-related Web sites that they do not understand. Additionally, Internet users may not know how to evaluate the quality of information they find, which could lead to them access inaccurate or irrelevant information. To aid in the process of finding and designing Web sites that are appropriate for patients, the current article provides guidelines for assessing readability and quality of health-related content. Additionally, a demonstration of an assessment is provided. Finally, limitations of these assessments are discussed.     

Pornography use and sexual aggression: the impact of frequency and type of pornography use on recidivism among sexual offenders

In this study, we examined the unique contribution of pornography consumption to the longitudinal prediction of criminal recidivism in a sample of 341 child molesters. We specifically tested the hypothesis, based on predictions informed by the confluence model of sexual aggression that pornography will be a risk factor for recidivism only for those individuals classified as relatively high risk for re-offending. Pornography use (frequency and type) was assessed through self-report and recidivism was measured using data from a national database from the Royal Canadian Mounted Police. Indices of recidivism, which were assessed up to 15 years after release, included an overall criminal recidivism index, as well as subcategories focusing on violent (including sexual) recidivism and sexual recidivism alone. Results for both frequency and type of pornography use were generally consistent with our predictions. Most importantly, after controlling for general and specific risk factors for sexual aggression, pornography added significantly to the prediction of recidivism. Statistical interactions indicated that frequency of pornography use was primarily a risk factor for higher-risk offenders, when compared with lower-risk offenders, and that content of pornography (i.e., pornography containing deviant content) was a risk factor for all groups. The importance of conceptualizing particular risk factors (e.g., pornography), within the context of other individual characteristics is discussed.     

Stress, depressive symptoms, and smoking cessation among pregnant women.

Perceived stress and depressive symptoms were examined as correlates and predictors of smoking cessation during pregnancy in a sample of 819 pregnant smokers (454 baseline smokers and 365 baseline quitters). Women who quit early in pregnancy had lower levels of stress and depressive symptoms than baseline smokers. Adjusting for level of addiction and other demographic factors related to stress and depressive symptoms eliminated the significant association between depressive symptoms and smoking cessation. Lower levels of stress and depressive symptoms were not predictive of cessation in later pregnancy. Prenatal healthcare providers should continue to assess level of addiction and provide targeted intensive cessation interventions. Interventions that reduce stress and depression may also be of benefit to women who are continuing smokers in early pregnancy.     

Integrating Motivating and Constraining Forces in Deviance Causation: A Test of Causal Chain Hypotheses in Control Balance Theory

ABSTRACT

A major innovation in control balance theory is the integration of motivating and constraining forces into a “causal chain” explanation of deviance. To test these relationships, this research presents a parsed model of the causal chain that focuses on the associations among control ratios, deviant motivation, situational provocations, constraint, and deviant behavior. Results from a first-person scenario testing hypotheses from this model show that, as predicted, control ratios affect deviance both directly and indirectly through motivating and constraining variables. While the full model explains about 39% of the variation in deviance, control ratios do not, however, show great explanatory power regarding variation in motivation and constraint.     

Academic Course Combining Psychological Skills Training and Life Skills Education for University Students and Student-Athletes

In Part II, we present two case studies of erotic transference and countertransference in sport psychology service delivery. We interviewed two seasoned practitioners, both with long histories of working with athletes. These sport psychologists represent two extremes of the spectrum when encountering the erotic in service delivery. One participant's story is about denial, suppression, and repression of anything that hints of the erotic in practitioner-client relationships. The other sport psychologist's story is about a nearly unbridled reveling in the erotic with a client. The practitioners are easy to condemn, one for ignorance and lack of awareness of self and others, the other for adolescent fantasies and objectification of his client. But those responses are facile and uncharitable. We present these two cases as examples, albeit extreme ones, of how truly complex the erotic is in service delivery. Their stories illustrate, in sometimes painful and graphic ways, what it is to be human, all-too-human, in our encounters with the people we serve.     

Implementation of nonparametric multivariate statistics with S

Multivariate nonparametric statistical methods have not been widely used by psychologists. One reason for this may have been that the usual general-purpose packages do not provide easy implementation of these methods. In this article, we briefly describe the multivariate extensions of the sign, signed-rank, and rank-sum tests and use S, a programming environment for data analysis, to implement these statistical procedures. Three numerical examples are used to illustrate the flexibility and efficiency of these computations in S.