An Investigation of Genetic Counselors’ Testing Recommendations: Pedigree Analysis and the Use of Multiplex Breast Cancer Panel Testing

Genetic testing recommendations for hereditary breast and ovarian cancer involve pedigree analysis and consultation of testing guidelines. The testing landscape for hereditary cancer syndromes is shifting as multiplex panel tests become more widely integrated into clinical practice. The purpose of the current study was to assess how genetic counselors utilize pedigrees to make recommendations for genetic testing, to determine consistency of these recommendations with National Comprehensive Cancer Network (NCCN) Guidelines and to explore current use of multiplex panel testing. Sixty-nine genetic counselors were recruited through the National Society of Genetic Counselors Cancer Special Interest Group’s Discussion Forum. Participation involved pedigree analysis and completion of an online questionnaire assessing testing recommendations and use of multiplex panel testing. Pedigree analysis and test recommendations were scored for consistency with NCCN guidelines. The average score was 12.83/15 indicating strong consistency with NCCN guidelines. Participants were more likely to consider multiplex testing when pedigrees demonstrated highly penetrant dominant inheritance but were not indicative of a particular syndrome. Participant concerns about multiplex panel testing include limited guidelines for both testing eligibility and medical management. This study demonstrates high utilization of pedigree analysis and raises new questions about its use in multiplex genetic testing.     

Long-Term Follow-Up of a Randomized Controlled Trial Comparing Acceptance and Commitment Therapy and Standard Cognitive Behavior Therapy for Anxiety and Depression

The present study represents one of the first comparisons of the long-term effectiveness of traditional cognitive behavior therapy (i.e., Beckian cognitive therapy; CT) and acceptance and commitment therapy (ACT). One hundred thirty-two anxious or depressed outpatients were randomly assigned to receive either CT or ACT, and were assessed at posttreatment (n = 90) and at 1.5-year (n = 91) follow-up. As previously reported, the two treatments were equivalently effective at posttreatment according to measures of depression, anxiety, overall (social/occupational/symptom-related) functioning, and quality of life. However, current results suggest that treatment gains were better maintained at follow-up in the CT condition. Clinical significance analyses revealed that, at follow-up, one-third more CT patients were in the clinically normative range in terms of depressive symptoms and more than twice as many CT patients were in the normative range in terms of functioning levels. The possible long-term advantage of CT relative to ACT in this population is discussed.     

Factors Associated with Psychological Distress among Women of African Descent at High Risk for BRCA Mutations

Little is known about psychological distress among women of African descent who are at high risk for a BRCA mutation. This is a group for whom breast cancer risk reduction is critical due to the group’s high rates of breast cancer mortality. Distress is important to consider as it may reduce the potential benefit of genetic counseling and negatively affect decision making related to risk reduction. The goals of the current study were to examine breast cancer-specific distress and depressive symptoms in women of African descent at who are at high risk for a BRCA mutation and to identify background factors associated with these outcomes. Participants were 148 high-risk African American and Caribbean women who were part of a larger study that offered participants BRCA counseling at no cost. Participants completed the Impact of Events Scale, which assessed breast cancer-specific distress, and the Center of Epidemiological Studies-Depression Scale, which assessed depressive symptoms. Results of analyses revealed that almost half of the sample achieved scores indicating high and clinically significant breast cancer-specific distress, while almost one-third had clinically significant depression scores. Results further showed that low income was significantly associated with cancer-specific distress, while having a cancer diagnosis was significantly associated with depressive symptoms. These results underscore the need for targeted psychological support throughout the genetic risk assessment process for this particular high-risk group.     

Developing an Acceptance-Based Behavioral Treatment for Binge Eating Disorder: Rationale and Challenges

Binge eating disorder (BED), characterized by recurrent eating episodes in which individuals eat an objectively large amount of food within a short time period accompanied by a sense of loss of control, is the most common eating disorder. While existing treatments, such as cognitive behavioral therapy (CBT), produce remission in a large percentage of individuals with BED, room for improvement in outcomes remains. Two reasons some patients may continue to experience binge eating after a course of treatment are: (a) Difficulty complying with the prescribed behavioral components of CBT due to the discomfort of implementing such strategies; and (b) a lack of focus in current treatments on strategies for coping with high levels of negative affect that often drive binge eating. To optimize treatment outcomes, it is therefore crucial to provide patients with strategies to overcome these issues. A small but growing body of research suggests that acceptance-based treatment approaches may be effective for the treatment of binge eating. The goal of the current paper is to describe the development of an acceptance-based group treatment for BED, discuss the structure of the manual and the rationale and challenges associated with integrating acceptance-based strategies into a CBT protocol, and to discuss clinical strategies for successfully implementing the intervention.     

Effects of social problem-solving training on classroom behavior of urban disadvantaged students

Sixty-four urban disadvantaged fourth- and fifth-grade students were assigned to one of the following four treatment conditions: social problem-solving training, response cost, social problem-solving training plus response cost, and no treatment control. Those exposed to problem-solving training improved on measures of alternative thinking and consequential thinking skills. The training, however, did not affect teacher ratings of student behavior or observed classroom behavioral functioning. In addition, the response cost procedure did not enhance acquisition or utilization of problem-solving skills.     

Measuring perceived stress in adolescents: a cross validation

A brief (24-item) version of the Adolescent Life Change Event Scale (ALCES), a self-report measure of stressfulness, was administered to 94 students between the ages of 12 and 29. Rank order coefficients computed between ratings obtained by the current sample and those obtained by the original sample exceeded .90. These results suggest ALCES may be a valid tool for use in stress research with adolescents.     

Family environment and its relation to adolescent personality factors

Investigated the relationship between family social climate characteristics and adolescent personality functioning. The High School Personality Questionnaire (HSPQ) was administered to 80 high school students. These students and their parents also completed the Family Environment Scale (FES). Results of a stepwise multiple regression analysis indicated that one or more HSPQ scales had significant associations with each FES scale. Significant variance in child behavior was attributed to family social system functioning; however, no single family variable accounted for a major portion of the variance to the exclusion of other factors. It was concluded that child behavior varies with total system functioning, more than with separate system factors.     

Common irrational beliefs associated with the psychophysiological conditions of low back pain,peptic ulcers and migraine headache: A multivariate study

Low back pain, peptic ulcers, migraine headache and a medical control were examined with respect to their irrational beliefs, age, sex and socioeconomic status. Two hundred and sixty-four subjects were diagnosed as having a psychosomatic condition or comprised the medical control group. Subjects were administered the Common Beliefs Survey III, (CBS III) (Bessai, 1977; 1978) and a personal data sheet. The data were analyzed by a multivariate analysis of variance (MANOVA) with dependent variables consisting of six mean factor scores of the CBS III age and socioeconomic status. The MANOVA found group differences on perfectionism. The psychosomatic groups were next combined and compared to the control by a component analysis of variance (CANOVA). The CANOVA found significance on perfectionism, and self-downing for the psychosomatic groups. Age and sex were analyzed and their results discussed. The results were discussed with respect to the experimental and control groups on the factor scores of the CBS III, age, and socioeconomic status.The study is part of a series of investigations conducted at Riverside Methodist Hospital under Drs. Donald J. Tosi and David R. Rudy. This study is based on a dissertation conducted by Dr. Michael A. Forman under the supervision of Dr. Donald J. Tosi. Reprint requests should be sent to: Dr. Forman