Stepped care for obsessive-compulsive disorder: An open trial

This study evaluated the effectiveness and treatment costs associated with a stepped care protocol of exposure and response prevention (EX/RP) for obsessive-compulsive disorder (OCD). In the current open trial, patients (N = 14) began with self-directed EX/RP and minimal therapist guidance over the course of six weeks (Step 1). During this phase of treatment, no therapist-directed exposures were conducted. Those who did not respond optimally to Step 1 went on to Step 2, which consisted of 15 sessions of twice-weekly therapist-directed exposures. Results of this study show promise for stepped care utilizing EX/RP for some patients with OCD, with a response rate of 88% and a 60% reduction on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score among treatment completers. Significant improvements were found in Y-BOCS from pre to post-treatment for both Step 1 and Step 2 completers. Forty-five percent of participants (n = 5) responded following completion of Step 1, resulting in reduced cost of treatment among these participants. All participants who responded to Step 1 maintained acute gains during the brief follow-up period. Limitations include a small sample size and high attrition rate.     

Perspective taking and prejudice reduction: the mediational role of empathy arousal and situational attributions

This research was designed to examine whether perspective taking promotes improved intergroup attitudes regardless of the extent that stereotypic perceptions of outgroups are endorsed, as well as examining the mechanisms (attributional or empathy related) by which perspective taking motivates improved intergroup attitudes. Participants were presented with an interview segment where an African American interviewee discussed the difficulties experienced as a result of his membership in a negatively stereotyped group. Materials were presented in a 2 (perspective taking: other focused or objective focused) × 2 (target stereotypicality: confirming or disconfirming) between participants design. Findings revealed that the manipulation of target stereotypicality influenced subsequent stereotype endorsement; those exposed to a stereotype confirming target later endorsed more stereotypic perceptions of African Americans than did those exposed to a stereotype disconfirming target. However, perspective taking promoted improved intergroup attitudes irrespective of stereotypicality; those encouraged to adopt the perspective of the target later reported more favourable intergroup attitudes than did those who remained detached and objective listeners. Whereas empathy partially mediated the relation between perspective taking and intergroup attitudes, situational attributions were a stronger and more reliable mediator. Copyright © 2003 John Wiley & Sons, Ltd.     

Reporting discrimination in public and private contexts.

The authors tested the hypothesis that members of stigmatized groups would be unwilling to report that negative events that occur to them are the result of discrimination when they are in the presence of members of a nonstigmatized group. Supporting this hypothesis, women and African Americans were more likely to report that a failing grade assigned by a man or a European American was caused by discrimination, rather than by their own lack of ability, when they made the judgment privately and in the presence of a fellow stigmatized group member. However, they were more likely to indicate that the cause of the failure was lack of ability, rather than discrimination, when they expected to make these judgments aloud in the presence of a nonstigmatized group member.     

Assessment of shame and guilt in a psychiatric sample: a comparison of two measures

The relationship between measures of shame, guilt, and psychopathology was examined in a heterogeneous inpatient sample (n=82) using the Test of Self-Conscious Affect (TOSCA) and the Personal Feelings Questionnaire-2 (PFQ-2). It was predicted that both shame scales would correlate positively with measures of psychopathology. This hypothesis was supported in bivariate analyses, however, when partialed for each respective guilt scale, only the TOSCA maintained significant associations with measures of psychopathology. It was predicted that only the PFQ-2 guilt scale would correlate positively with measures of psychopathology, and this hypothesis was supported in both bivariate analyses and partial correlations, controlling for shame scores. These findings support previous work, suggesting that the TOSCA and PFQ-2 guilt scales assess different constructs of guilt. Methodological issues of shame and guilt assessment with psychiatric patients also are discussed.     

A Revision of the Multicultural Counseling Awareness Scale

This article reports the results of 2 studies designed to test and revise the Multicultural Counseling Awareness Scale (J. G. Ponterotto et al., 1996). Collective results support the 2‐factor extraction (Knowledge and Awareness) as the best fit model and provide initial indices of validity and internal consistency reliability for the newly titled Multicultural Counseling Knowledge and Awareness Scale. Este artículo informa los resultados de 2 estudios diseñados para probar y revisar la Escala de Conciencia de Consejería Multicultural (J. G. Ponterotto et al., 1996). Los resultados colectivos sostienen la extracción de 2 factures (el Conocimiento y la Conciencia) como el mejor modelo y proporcionan los índices iniciales de validez y fiabilidad de la consistencia interna para la nuevamente titulada Escala de Conocimiento y Conciencia de Consejería Multicultural.     

Instructional set and internet use by low-income adults.

This research examined the effects of instructional set on Internet use by low-income adults during a 16-month longitudinal study. Participants (n = 117) received instructions that focused on either the Internet's communication tools or its information tools. Internet use was continuously and automatically recorded. Survey measures of computer and Internet experiences, affect and attitudes were obtained to examine their mediational role in the relationship between instructional set and Internet use. Results indicated that instructions focused on the Internet's information tools led to greater Internet use than instructions focused on its communication tools or only basic instructions about how to use the Internet. Implications for reducing the digital divide are discussed.     

The combined effects of risk and time on choice: Does uncertainty eliminate the immediacy effect? Does delay eliminate the certainty effect?

Researchers have noted parallels between decisions under uncertainty and over time. Three experiments evaluated the theory that uncertainty and time affect choice via a common underlying dimension, such that delaying an outcome is equivalent to making it uncertain. To test this account we asked whether adding uncertainty to outcomes would eliminate the immediacy effect bias. We also asked whether adding time delay to outcomes would eliminate the certainty effect bias. The answer to both questions was yes, provided the prospects were presented singly rather than jointly. In single evaluation uncertainly eliminated the immediacy effect and delay eliminated one form of the certainty effect, while in joint evaluation, these effects did not occur. These findings suggest that at least in some contexts decision makers may equate risk and delay. Other explanations are possible, however, demonstrating that the interaction between risk and delay is complex and not easily understood.     

Trichotillomania: impact on psychosocial functioning and quality of life

This study explored the impact of hair pulling on psychosocial functioning for patients diagnosed with trichotillomania (TTM; n = 28). TTM patients were compared to age and gender-matched groups of psychiatric patients without TTM (n = 28) and nonpsychiatric control volunteers (NC, n = 28) on measures of psychological distress, functioning/quality of life, and self-esteem. Results indicated that TTM patients reported more severe psychosocial impairments than did NC volunteers; however, these differences were mediated by differences in level of depression. Regression analyses indicated significant relationships between some measures of psychosocial functioning and severity of hair pulling, independent of level of depression. Finally, an interview of the impact of hair pulling on 6 domains of daily functioning (negative affect/negative self-evaluations, grooming, recreational activities, social interaction, work/housework productivity, and physical health) indicated common and wide-ranging impairments for both lifetime and current (i.e., past week) ratings. These results highlight the importance of promoting and improving resources for the clinical care of TTM patients, and provide some directions for clinicians to enhance assessment of interference caused by TTM.     

The effects of accountability on bias in physician decision making: Going from bad to worse

Members of the Iowa Academy of Family Physicians participated in a survey study in which they were asked to make hypothetical decisions in either high- or low-conflict treatment conditions. In the low-conflict treatment condition the options were a common medication with a referral or a referral only. In the high-conflict treatment condition the same two options were given plus another attractive medication. In addition, we manipulated accountability by asking half of the participants to provide a written defense of their treatment options, which they would then agree to discuss at a later time. The results showed that physicians in the high-conflict condition chose the referral-only option significantly more than the physicians in the low-conflict condition, thus violating the normative rule of regularity. Moreover, that pattern was significantly amplified for physicians who were held accountable for their treatment decisions. These findings replicate and extend previous research and are discussed within the framework of reason-based choice.