Giving Voice to Patients: Developing a Discussion Method to Involve Patients in Translational Research

Biomedical research policy in recent years has often tried to make such research more ‘translational’, aiming to facilitate the transfer of insights from research and development (R&D) to health care for the benefit of future users. Involving patients in deliberations about and design of biomedical research may increase the quality of R&D and of resulting innovations and thus contribute to translation. However, patient involvement in biomedical research is not an easy feat. This paper discusses the development of a method for involving patients in (translational) biomedical research aiming to address its main challenges.After reviewing the potential challenges of patient involvement, we formulate three requirements for any method to meaningfully involve patients in (translational) biomedical research. It should enable patients (1) to put forward their experiential knowledge, (2) to develop a rich view of what an envisioned innovation might look like and do, and (3) to connect their experiential knowledge with the envisioned innovation. We then describe how we developed the card-based discussion method ‘Voice of patients’, and discuss to what extent the method, when used in four focus groups, satisfied these requirements. We conclude that the method is quite successful in mobilising patients’ experiential knowledge, in stimulating their imaginaries of the innovation under discussion and to some extent also in connecting these two. More work is needed to translate patients’ considerations into recommendations relevant to researchers’ activities. It also seems wise to broaden the audience for patients’ considerations to other actors working on a specific innovation.     

The Anxiety Depression Distress Inventory–27 (ADDI–27): New Evidence of Factor Structure,Item-Level Measurement Invariance,and Validity

Three studies examining the factor structure and psychometric properties of the Anxiety Depression Distress Inventory–27 (ADDI–27) extended the initial instrument development studies for this recently introduced inventory. The ADDI–27 is an empirically derived short form of the Mood and Anxiety Questionaire–90 (MASQ–90) comprising three scales: Positive Affect, Somatic Anxiety, and General Distress. The main objectives of Study 1 (N = 700) were to examine the factor structure of the ADDI–27 and its measurement invariance across gender at the item level. The objective of Study 2 (N = 538) was to examine evidence for the convergent and discriminant validity of scores on the ADDI–27. The objective of Study 3 (N = 240) was to assess further evidence for the nomological network and convergent and discriminant validity of the ADDI–27 scores. Results of exploratory structural equation modeling yielded strong support for a 3-factor model, with approximate fit indexes meeting or exceeding the conventional cutoffs. With p ≤ .001 as the criterion for detecting noninvariance, results of measurement invariance analysis suggested that all of the ADDI–27 items were invariant across gender. Results of multivariate validity analyses across 2 studies provided support for the convergent and discriminant validity of scores on the ADDI–27 scales.     

The Relationship Between Automatic Thoughts and Irrational Beliefs Predicting Anxiety and Depression

Cognitive behavioral approaches differ in their views on core cognitions and their hypothesized role in the etiology of depression and anxiety. The present study provides empirical evidence regarding the relationship between irrational beliefs and components of automatic thoughts and their role in the etiology of depression and anxiety. The present study utilized newer and improved questionnaires to assess components of irrational belief. Based on prior research by Safren et al. (Cogn Ther Res 24(3):327–344, 2000), a three-factor structure of the combined automatic thought questionnaires were utilized to measure components of automatic thoughts as they relate to depression and anxiety. Factor analytical methods were utilized to confirm the factor structure of the irrational beliefs and automatic thoughts components. Advanced path modeling was utilized to model the relationship between irrational beliefs and automatic thoughts in predicting anxiety and depression. The study used a sample of N = 542 undergraduate psychology students during stressful exam times. Results indicated that the irrational belief Demandingness represents a primary factor, followed by the secondary irrational beliefs as proposed by Rational Emotive Behavioral Theory. Selfdowning beliefs were fully mediated by depressive automatic thoughts in the case of depressive affect. Low frustration tolerance contributed unique variance to anxious and depressive affect that was not fully mediated by automatic thoughts. Results from the present study add empirical evidence that irrational beliefs indeed represent core and intermediary beliefs that lead to specific automatic thoughts, which is congruent with cognitive behavioral theory as proposed by Rational Emotive Behavioral Therapy.     

Philosophical Idling and Philosophical Relativity

Peter Unger has challenged philosophical objectivism, the thesis that traditional philosophical problems have definite objective answers. He argues from semantic relativity for philosophical relativity, the thesis that for certain philosophical problems, there is no objective answer. I clarify, formulate and challenge Unger's argument. According to Unger, philosophical relativism explains philosophical idling, the fact that philosophical debates appear endless, philosophical disagreements seem irresolvable, and very little substantial progress seems made towards satisfactory and definite answers to philosophical problems. I argue, however, that the reality of philosophical idling is doubtful and, ironically, undermined by philosophical relativism. I then raise problems for several steps in Unger's argument for philosophical relativity. I conclude by arguing that philosophical relativism can avoid self‐defeat only by an ad hoc limitation of its scope. 1     

Hippocampal train stimulation modulates recall of fear extinction independently of prefrontal cortex synaptic plasticity and lesions

It has been shown that long-term potentiation (LTP) develops in the connection between the mediodorsal thalamus (MD) and the medial prefrontal cortex (mPFC) and between the hippocampus (HPC) and the mPFC following fear extinction, and correlates with extinction retention. However, recent lesion studies have shown that combined lesions of the MD and mPFC do not interfere with extinction learning and retention, while inactivation of the dorsal HPC disrupts fear extinction memory. Here we found in rats that immediate post-training HPC low-frequency stimulation (LFS) suppressed extinction-related LTP in the HPC-mPFC pathway and induced difficulties in extinction recall. HPC tetanus, applied several hours later, failed to re-establish mPFC LTP but facilitated recall of extinction. Delayed post-training HPC LFS also provoked mPFC depotentiation and difficulties with extinction recall. HPC tetanus abolished these two effects. We also found that damage to the mPFC induced fear return only in rats that received HPC LFS following extinction training. HPC tetanus also reversed this behavioral effect of HPC LFS in lesioned rats. These data suggest that the HPC interacts with the mPFC during fear extinction, but can modulate fear extinction independently of this interaction.     

Electrolytic lesions of the medial prefrontal cortex do not interfere with long-term memory of extinction of conditioned fear

Lesion studies indicate that rats without the medial prefrontal cortex (mPFC) have difficulty recalling fear extinction acquired the previous day. Several electrophysiological studies have also supported this observation by demonstrating that extinction-related increases in neuronal activity in the mPFC participate in expression of fear extinction. However, a more recent study has shown that fear extinction can be recalled, in certain circumstances, without mPFC potentiation, suggesting contribution of other circuits. Here, we examined this possibility in rats that were subjected to auditory fear conditioning, extinction training, and extinction retention test 7 d later. Electrolytic lesions were made in the mPFC, the motor cortex (MO), the dorsal septum (SEP), or the mediodorsal thalamus (MD), because of their potential participation in conditioned fear inhibition; combined lesions including the mPFC with the MO, SEP, or MD were also made. The lesions were made either 1 wk before conditioning or 1 d after extinction training. All rats normally extinguished their conditioned freezing behavior during extinction training and did not display any return of this behavior during the retention test. These data reveal that the mPFC is not required for the acquisition, the expression, or the retrieval of extinction memories but do not exclude the possibility that the mPFC normally participates in these processes.     

The psychology of engagement with indigenous identities: a cultural perspective

In a questionnaire study among 124 students at Haskell Indian Nations University, the authors investigated the hypothesis that engagement with Indigenous identity--assessed along three dimensions including degree (identification scale), content (panethnic or tribal nation), and context (reservation or nonreservation)--can serve as a psychological resource for well-being and liberation from oppression. Consistent with this hypothesis, degree of identification was positively correlated with community efficacy and perception of racism. Apparently inconsistent with this hypothesis, degree of identification among students who had resided on a reservation was negatively correlated with the Social Self-Esteem subscale of the Current Thoughts Scale. Rather than evidence against the identity-as-resource hypothesis, this pattern may reflect the cultural grounding of self-esteem and tools designed to measure it.     

A point contingency for homework submission in the graduate school classroom

We explored the effects of points versus no points on the submission of homework assignments and quiz performance in a graduate-level course. Students were more likely to submit homework assignments during points weeks, but quiz scores were relatively unaffected.