Social support and prognosis in patients at increased psychosocial risk recovering from myocardial infarction.

OBJECTIVE: To compare the impact of network support and different types of perceived functional support on all-cause mortality or nonfatal reinfarction for patients with a recent acute myocardial infarction (AMI). DESIGN: Participants were recruited from the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial; 2,481 AMI patients with depression or low social support were randomized to a cognitive-behavioral intervention or to a usual care control group. Data collection for certain measures of social support was limited: 2,466 participants completed the ENRICHD Social Support Inventory; 2,457 completed the Perceived Social Support Scale; 1,296 completed the Social Network Questionnaire; and 707 completed the Interpersonal Support and Evaluation List, Tangible Support subscale. Patients also completed the Beck Depression Inventory and were followed for up to 4.5 years. MAIN OUTCOME MEASURE: Time to death or nonfatal reinfarction. RESULTS: Over the follow-up period, 599 patients (24%) died or had a nonfatal AMI. Survival models controlling age, sex, race, socioeconomic status, smoking, antidepressant use, and a composite measure of increased risk revealed that higher levels of perceived social support were associated with improved outcome for patients without elevated depression but not for patients with high levels of depression. Neither perceived tangible support nor network support were associated with more frequent adverse events. CONCLUSION: AMI patients should be assessed for multiple dimensions of perceived functional support and depression to identify those at increased psychosocial risk who may benefit from treatment.     

Romantic Relationships and Health: An Examination of Individuals’ Perceptions of their Romantic Partners’ Influences on their Health

This study examines individuals’ perceptions of the impact their significant others have on their health and the extent to which these perceptions are associated with relationship quality and actual health. Two-hundred and ten participants (105 U.S. couples; mean age = 24.93) completed measures of their relationship quality and health along with an open-ended measure asking them to indicate how they felt their partner influenced their health. Results indicated that participants perceived their romantic partners to be primarily positive health influences, women believed their partners were more influential than did men, and eating and physical activity behaviors were believed to be most affected by partners. Participants’ relationship quality and health were associated with their reports of their perceived partners’ health influences. The research described in this report was supported by an award to Charlotte Markey from Rutgers University.     

Adolescents' performance on the Iowa Gambling Task: implications for the development of decision making and ventromedial prefrontal cortex

Healthy adolescents (79 girls, 66 boys), ages 9-17, completed the Iowa Gambling Task (IGT; A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994) as well as working memory (digit span) and behavioral inhibition (go/no-go) tasks. Cross-sectional age-related changes were seen on all 3 tasks. Gender differences were seen in IGT deck preference and attentional variables (i.e., go/no-go hit rate and forward digit span). After age, gender, and general intellectual abilities were controlled for, IGT performance was not predicted by working memory or behavioral inhibition scores. Findings suggest that the ventromedial prefrontal cortex or its connections are functionally maturing during adolescence in a manner that can be distinguished from maturation of other prefrontal regions. Development of these functions may continue into young adulthood.     

An Empowerment Evaluation Model for Sexual Assault Programs: Empirical Evidence of Effectiveness

Using an empowerment evaluation approach, the Sexual Assault and Rape Prevention (SARP) Evaluation Project brought together university researchers, public health evaluators, state funders, and program staff to provide evaluation training and consultation to all state-funded rape prevention and victim services programs in Michigan. In this paper, the specific activities of the SARP project are described, and process and outcome data are presented that address the effectiveness of this empowerment evaluation approach. Based on subjective reports from program staff and objective data obtained from state funders, results suggest that this evaluation model was successful in helping 90% of the prevention programs and 75% of the victim services programs successfully develop and launch program evaluations. One-year follow-up data indicate that 90% of the programs had sustained their evaluation efforts after the formal work of the SARP project had ended.     

The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials

This article provides a critical review of the assumptions and findings of studies used to establish psychotherapies as empirically supported. The attempt to identify empirically supported therapies (ESTs) imposes particular assumptions on the use of randomized controlled trial (RCT) methodology that appear to be valid for some disorders and treatments (notably exposure-based treatments of specific anxiety symptoms) but substantially violated for others. Meta-analytic studies support a more nuanced view of treatment efficacy than implied by a dichotomous judgment of supported versus unsupported. The authors recommend changes in reporting practices to maximize the clinical utility of RCTs, describe alternative methodologies that may be useful when the assumptions underlying EST methodology are violated, and suggest a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies.     

Appearance-related social comparisons: the role of contingent self-esteem and self-perceptions of attractiveness

Two studies examined contingent self-esteem (CSE) and responses to appearance-related social comparisons. Study 1 was an experimental study in which women rated a series of advertisements from popular women's magazines. Study 2 employed an event-contingent diary recording procedure. In Study 1, women who were higher in CSE and lower in self-perceptions of attractiveness (SPA) experienced greater decreases in positive affect and greater increases in negative affect following the ad-rating task. Study 2 results supported a mediation model in which women who were higher in CSE felt worse after social comparisons because they made primarily upward comparisons. Overall, results suggest that appearance-related comparisons are more distressing for those who base their self-worth on contingencies and have lower self-perceived attractiveness.     

Implicit theories of relationships: moderators of the link between conflict and commitment

In two studies, implicit theories of relationships were examined as moderators of the association between experienced conflict and commitment. Study 1 involved 128 individuals in heterosexual romantic relationships and employed an event-contingent diary procedure in which disagreements were recorded throughout a 10-day period. Study 2 was conducted in the laboratory and involved 75 heterosexual couples who discussed problems in their relationship, with commitment measured before and after discussion. Multilevel random coefficient models revealed that conflict was generally associated with lower commitment but less so with growth belief. Also, growth belief was most beneficial under negative relationship conditions, such as when one possessed a less favorable view of the partner to begin with and when the issue remained unresolved after discussion.     

Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients

To investigate how time perception may contribute to the symptoms of self-harming Borderline Personality Disorder (BPD) patients, 19 self-harming BPD inpatients and 39 normal controls were given measures of time perception, impulsivity, personality, emotion, and BPD characteristics. A test sensitive to orbitofrontal cortex (OFC) function ("Frontal" Behavior Questionnaire) was also administered, as the OFC has been associated with impulsivity and time perception. BPD patients produced less time than controls, and this correlated with impulsiveness and other characteristics commonly associated with BPD. BPD patients were also less conscientious, extraverted, and open to experience, as well as more impulsive (self-report and behaviorally), emotional, neurotic, and reported more BPD characteristics, compared to controls. The results suggest that some of these core characteristics of BPD may be on a continuum with the normal population and, impulsivity in particular, may be related to time perception deficits (i.e., a faster subjective sense of time). Finally, BPD patients scored higher on the Frontal Behavior Questionnaire, suggesting that some symptoms of the BPD syndrome may be related to problems associated with the OFC. A control spatial working memory task (SWM) revealed that SWM deficits could not explain any of the BPD patients' poor performance. While impulsivity was correlated with time perception across all participants, emotionality, introversion, and lack of openness to experience were not. This suggests that different symptoms of the borderline personality syndrome may be separable, and therefore, related to different cognitive deficits, and potentially to different brain systems. This may have important implications for treatment strategies for BPD.     

Vantage point in traumatic memory

Abstract— Persons with posttraumatic stress disorder (PTSD) spontaneously recalled the traumatic event that led to their condition from either a field or an observer vantage point. In the former case, participants recollected the event as if they were seeing it again through their own eyes; in the latter case, the event was recalled from the perspective of a detached spectator. Analysis of the two types of recollections revealed marked differences in their contents. Whereas field memories afforded richer accounts of the affective reactions, somatic sensations, and psychological states that participants experienced during the focal trauma, observer memories contained more information about participants' physical appearance and actions and the spatial layout of the traumatic scene. Observer trauma memories were also experienced as less emotional and anxiety provoking than field trauma memories. The discussion focuses on the clinical implications of these findings and prospects for future research on traumatic memory.