Family factors in childhood obesity

Abstract

Childhood obesity is reaching epidemic proportions in the United States today. Children become its victims and often carry obesity-producing habits into adulthood. Much research has been reported on obesity, but little has touched on how family dynamics affect childhood obesity. This article explores the family dynamics of childhood obesity, and presents evidence supporting the need for a family-based treatment model.     

Measuring Responsiveness in the Therapeutic Relationship: A Patient Perspective

This article reports results from a three-country study of patient perceptions of physician responsiveness. Based on existing research in the medical and social-psychological literatures, we theorized that patients' perceptions of physician responsiveness to their needs would be an important component of the patient–physician relationship and that this construct could be distinguished reliably from more global assessments of patient satisfaction. We then developed a new measure designed to assess these perceptions from the patients' point of view. This measure was administered to large samples of patients in the United States, the United Kingdom, and Canada. Results supported our hypotheses. Patient perception of physician responsiveness significantly predicted both patient satisfaction and subjective health-related problems, over and above effects attributable to general satisfaction. We also noted the absence of significant differences across the three cultures or sex, suggesting that the process we identify has considerable generality. We also describe a short version of our measure that researchers may find useful in a variety of research or clinical settings.     

Behavioral Skills Training With Teachers: Booster Training for Improved Maintenance

Behavioral skills training (BST) has been employed within many different populations for the reduction of problem behaviors and acquisition of new skills; however, these changes have not always maintained over time. This study evaluated the effects of a booster training for re-establishing the classroom management proficiencies that teachers had acquired previously, but had declined over a 12-month period. The single-subject experimental results showed the booster training to be effective in re-establishing teacher performance of skills as measured by both analogue role-play and in situ postassessments within the classroom. These findings suggest that a booster training utilizing BST may be an important strategy for maintaining skill performance over time.     

Learning and Affect Following Near‐Miss Outcomes in Simulated Gambling

Gambling near‐misses are non‐rewarded events that resemble a winning configuration. Past research using slot machines has shown that moderate rates of near‐misses increase gambling persistence, but the mechanisms supporting this persistence are unclear. One hypothesis is that near‐misses are mistakenly interpreted as signals of skill acquisition, supporting learning and fuelling the ‘illusion of control’. A slot machine simulation was administered to 60 volunteers, with ratings of the perceived chances of winning, pleasure and motivation to play following particular outcomes. Psychophysiological measures (electrodermal activity and heart rate) were taken, and gambling persistence was measured after 30 trials. Near‐misses were similar to full‐miss outcomes in that they were regarded as unpleasant. However, near‐misses were akin to win outcomes in that they increased motivations to play and electrodermal activity. Learning was evidenced by the expectancy of winning increasing following wins and decreasing after losses. Although there was no overall change in expectancy of winning after near‐misses across all participants, those subjects reporting a greater increase in the expectancy of winning following a near‐miss showed more persistent play, consistent with the learning hypothesis. Greater heart rate acceleration following near‐misses was also associated with persistence. We also observed differential effects of near‐misses where the reel stopped either side of the winning position (‘payline’): motivational effects were restricted to near‐misses stopping before the payline, whereas near‐misses that stopped after the payline were primarily aversive. The payline effects are not predicted by the learning hypothesis and may indicate an affective component to near‐misses, possibly linked to counterfactual processing. Copyright © 2012 John Wiley & Sons, Ltd.     

The role of stress and area‐specific self‐esteem in adolescent smoking

Stress and self‐esteem have been shown to be important risk factors for adolescent cigarette smoking, and self‐esteem has previously been implicated as a stress‐moderating and a stress‐mediating variable. This study aimed to examine the associations between stress, area‐specific self‐esteem, and adolescent smoking, and to investigate whether specific areas of self‐esteem moderate or mediate the relationship between stress and smoking. Four hundred and ninety‐five adolescents (aged 14–19) responded to a questionnaire that examined these variables. Results showed that self‐esteem in the areas of school subjects and parent relations were related to smoking. Adolescents with low self‐esteem in these areas were more likely to smoke than their high self‐esteem counterparts. Highly stressed adolescents were more likely to smoke than those with low stress. However, the relationship between stress and smoking was completely mediated by self‐esteem in the area of school subjects. No moderation was revealed. Thus, high global self‐esteem may not be sufficient to reduce the risk of smoking. To maximise benefit, prevention and intervention efforts should target self‐esteem in the areas of school subjects and parent relations. Initiatives focusing on stress are only likely to decrease smoking to the extent that they influence self‐esteem in the area of school subjects.     

Enhancing recovery rates: Lessons from year one of IAPT

BackgroundThe English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.MethodData from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).ResultsData completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.ConclusionsCompliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.     

Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.