Pediatric trichotillomania: descriptive psychopathology and an open trial of cognitive behavioral therapy

In study 1, 46 children and adolescents with trichotillomania who sought treatment at 2 specialty outpatient clinics were assessed. Most children reported pulling hair from multiple sites on the body, presented with readily visible alopecia, reported spending 30-60 minutes per day pulling or thinking about pulling, and reported experiencing significant distress about their symptoms. Most were described by their parents as having significant problems in school functioning. Few children met criteria for obsessive-compulsive disorder or tic disorder. Child and family rates of other forms of psychopathology were high. In study 2, 22 of these children were enrolled in an open trial of individual cognitive behavioral therapy with particular attention to relapse prevention. Trichotillomania severity decreased significantly and 77% of children were classified as treatment responders at post-treatment and 64% at 6-month follow-up.     

Changes in quality of life following cognitive-behavioral therapy for obsessive-compulsive disorder

Cognitive-behavioral therapy (CBT) incorporating exposure and response prevention is a first line treatment for obsessive-compulsive disorder (OCD). Although, the efficacy of CBT in reducing OCD symptoms is well documented, less is known about its effects on quality of life (QOL). In the current study, functional impairment aspects of QOL (as measured by the Sheehan Disability Scale) were assessed among 70 adult outpatients with OCD before and after CBT. Statistically significant improvements in QOL and large pre- to post-treatment effect sizes were observed for work, social, and family functioning. Improvements in social and family functioning were predicted by improvements in OCD symptom severity even after controlling for improvements in depressive symptoms. In addition, clinically significant change in OCD symptoms and QOL were highly related, although there was a subset of participants whose symptoms improved without corresponding improvements in QOL. These results suggest that the effects of CBT may extend beyond OCD symptom reduction to QOL.     

Does Time Fly When You are Having Fun? A Day Reconstruction Method Analysis

Duration-based measures of happiness from retrospectively constructed daily diaries are gaining in popularity in population-based studies of the hedonic experience. Yet experimental evidence suggests that perceptions of duration—how long an event lasts—are influenced by individuals’ emotional experiences during the event. An important remaining question is whether observational measures of duration outside the laboratory setting, where the events under study are engaged in voluntarily, may be similarly affected, and if so, for which emotions are duration biases a potential concern. This study assesses how duration and emotions co-vary using retrospective, 24-h diaries from a national sample of older couples. Data are from the Disability and Use of Time supplement to the nationally representative U.S. Panel Study of Income Dynamics. We find that experienced wellbeing (positive, negative emotion) and activity duration are inversely associated. Specific positive emotions (happy, calm) are not associated with duration, but all measures of negative wellbeing considered here (frustrated, worried, sad, tired, and pain) have positive correlations (ranging from 0.04 to 0.08; p < .05). However, only frustration remains correlated with duration after controlling for respondent, activity and day-related characteristics (0.06, p < .01). The correlation translates into a potentially upward biased estimate of duration of up to 10 min (20 %) for very frustrating activities. We conclude that estimates of time spent feeling happy yesterday generated from diary data are unlikely to be biased but more research is needed on the link between duration estimation and feelings of frustration.     

Impact of Youth Strengths and Objective Strain on the Experiences of Subjective Strain Among Caregivers of Youth with Behavioral Health Conditions

Caregivers of youth with behavioral health conditions often experience significant and chronic caregiving strain. Caregiving strain is thought to consist of three dimensions: objective strain (observable negative events), subjective internalized strain (negative feelings directed inwardly), and subjective externalized strain (negative feelings directed outwardly). Based on a modified stress process model, the aims of this study were to: (1) examine whether the association between youth emotional-behavioral problem severity (measured with the Child Behavior Checklist/6–18) and subjective internalized and subjective externalized caregiving strain is mediated by objective strain for caregivers, and; (2) identify other predictors of subjective internalized and subjective externalized strain, particularly related to youth emotional-behavioral strengths as measured by the Behavioral and Emotional Rating Scale-Parent Rating Scale. We also explored the extent to which the association between youth emotional-behavioral problem severity and subjective internalized and subjective externalized strain may be moderated by perceived youth emotional-behavioral strengths. One-hundred and eighty-five (N = 185) caregivers of youth served by a community-based system of care participated in structured survey interviews at program enrollment. Regression analyses indicated that objective strain was found to fully mediate the association between youth emotional-behavioral problem severity and subjective externalized strain. Greater youth strengths related to family involvement were also associated with lower subjective externalized strain. Higher caregiver age, lower education, biological parent relationship to youth, greater youth emotional-behavioral problem severity, higher objective strain, and lower youth strengths related to school functioning were associated with higher subjective internalized strain. A significant interaction was found between youth problem severity, youth affective strengths, and subjective internalized strain such that caregivers who reported higher levels of youth affective strengths experienced stronger effects from youth emotional-behavioral problem severity on subjective internalized strain. These findings shed light upon the complex set of circumstances that may lead caregivers of youth with behavioral health conditions to experience subjective internalized and subjective externalized strain.     

Developing New Academic Programs in the Medical/Health Humanities: A Toolkit to Support Continued Growth

Journal of Medical Humanities - Academic programs in the medical/health humanities have proliferated widely in recent years, and the professional, academic, and cultural drivers of this growth...     

Understanding the Adoptive Family within the Context of Christian Hospitality

Abstract : Adoptive families can take many forms, yet there are similarities across adoptive family types that can be studied. Relevant research regarding the adoptive kinship network, openness and contact in adoption, family communication about adoption, adoption‐related curiosity and information‐seeking, and adoptive identity is reviewed. Christian hospitality is provided as a context within which adoptive families are formed and understood.     

The Latent Structure of the Center for Epidemiological Studies-Depression Scale

Taxometric analyses were used to assess the latent structure of depressive symptoms as measured by the Center for Epidemiological Studies Depression (CES-D) scale. Participants were 3,395 college students enrolled in Introductory Psychology classes at a mid-size university. Analyses included data simulation strategies to assure that the data was appropriate for interpreting skewed indicators and small putative taxa. Four indicators (depressed mood, positive affect, somatic, and interpersonal symptoms) were derived from principal components analysis. Taxometric analyses indicated that distributions of the four CES-D factor based indicators were dimensional. Results are consistent with a continuity model of the latent structure of questionnaire measures of depressive symptoms in this young adult population, of which approximately 15% scored above the clinical cut-point for the CES-D scale.     

Using game theory to examine incentives in influenza vaccination behavior

The social good often depends on the altruistic behavior of specific individuals. For example, epidemiological studies of influenza indicate that elderly individuals, who face the highest mortality risk, are best protected by vaccination of young individuals, who contribute most to disease transmission. To examine the conditions under which young people would get vaccinated to protect elderly people, we conducted a game-theory experiment that mirrored real-world influenza transmission, with "young" players contributing more than "elderly" players to herd immunity. Participants could spend points to get vaccinated and reduce the risk of influenza. When players were paid according to individual point totals, more elderly than young players got vaccinated, a finding consistent with the Nash equilibrium predicting self-interested behavior. When players were paid according to group point totals, however, more young than elderly players got vaccinated-a finding consistent with the utilitarian equilibrium predicting group-optimal behavior-which resulted in higher point totals than when players were paid for their individual totals. Thus, payout structure affected whether individuals got vaccinated for self-interest or group benefit.