Quality of life is a process not an outcome

Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been well rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of ??listening?? to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome.     

Differential effects of psychopathy and antisocial personality disorder symptoms on cognitive and fear processing in female offenders

Psychopathy and antisocial personality disorder (APD) have long been considered important risk factors for criminal behavior and incarceration. However, little is known about the psychobiological underpinnings that give rise to the disinhibited behavior of female offenders. Using an instructed fear-conditioning paradigm and a sample of incarcerated female offenders, we manipulated attentional focus and cognitive load to characterize and differentiate between the dysfunctional cognitive and affective processes associated with these syndromes. We used fear-potentiated startle (FPS) and event-related potentials as measures of affective and cognitive processing, respectively. After controlling for APD symptoms, psychopathic women displayed greater FPS while attending directly to threat-relevant stimuli and displayed less FPS while performing a demanding task that directed attention to threat-irrelevant information. Conversely, controlling for psychopathy, women with high APD symptoms displayed less overall FPS, especially when instructed to focus on threat-relevant stimuli. However, as the demands on cognitive resources increased, they displayed greater FPS. For both psychopathy and APD, analysis of the event-related potentials qualified these findings and further specified the abnormal cognitive processes associated with these two syndromes. Overall, simultaneous analysis of psychopathy and APD revealed distinct patterns of cognitive processing and fear reactivity.     

Executive function in Parkinson’s disease: contributions of the dorsal frontostriatal pathways to action and motivation

Disruption of the dorsal frontostriatal pathways in Parkinson’s disease (PD) is associated with impairments in motivation, as well as in executive function. The goal of this study was to investigate whether these impairments are related and, if so, whether the disruption of frontostriatal pathways compromises the ability to process the motivational aspects of feedback in such tasks. In Experiment 1, informative feedback improved the performance of young, healthy participants in a task-switching paradigm. This task-switching paradigm was then used in Experiment 2 to test whether feedback would improve the performance of 17 PD patients and age-matched controls. The PD group benefitted from feedback to the same degree as control participants; however, depression scores on the Beck Depression Inventory were significantly related to feedback usage, especially when response selection demands were high. Regardless of feedback, PD patients were more impaired when response demands were high than in an equally difficult condition with low action demands. These results suggest that response selection is a core impairment of insufficient dopamine to the dorsal frontal striatal pathways.     

Mindfulness and its relationship to emotional regulation

Research on the effectiveness and mechanisms of mindfulness training applied in psychotherapy is still in its infancy (Erisman & Roemer, 2010). For instance, little is known about the extent and processes through which mindfulness practice improves emotion regulation. This experience sampling study assessed the relationship between mindfulness, emotion differentiation, emotion lability, and emotional difficulties. Young adult participants reported their current emotional experiences 6 times per day during 1 week on a PalmPilot device. Based on these reports of emotions, indices of emotional differentiation and emotion lability were composed for negative and positive emotions. Mindfulness was associated with greater emotion differentiation and less emotional difficulties (i.e., emotion lability and self-reported emotion dysregulation). Mediational models indicated that the relationship between mindfulness and emotion lability was mediated by emotion differentiation. Furthermore, emotion regulation mediated the relationship between mindfulness and both negative emotion lability and positive emotion differentiation. This experience sampling study indicates that self-reported levels of mindfulness are related to higher levels of differentiation of one's discrete emotional experiences in a manner reflective of effective emotion regulation.     

The substitutability of physical and social warmth in daily life

Classic and contemporary research on person perception has demonstrated the paramount importance of interpersonal warmth. Recent research on embodied cognition has shown that feelings of social warmth or coldness can be induced by experiences of physical warmth or coldness, and vice versa. Here we show that people tend to self-regulate their feelings of social warmth through applications of physical warmth, apparently without explicit awareness of doing so. In Study 1, higher scores on a measure of chronic loneliness (social coldness) were associated with an increased tendency to take warm baths or showers. In Study 2, a physical coldness manipulation significantly increased feelings of loneliness. In Study 3, needs for social affiliation and for emotion regulation, triggered by recall of a past rejection experience, were subsequently eliminated by an interpolated physical warmth experience. Study 4 provided evidence that people are not explicitly aware of the relationship between physical and social warmth (coldness), as they do not consider a target person who often bathes to be any lonelier than one who does not, with all else being equal. Together, these findings suggest that physical and social warmth are to some extent substitutable in daily life and that this substitution reflects an unconscious self-regulatory mechanism.     

Would introverts be better off if they acted more like extraverts? Exploring emotional and cognitive consequences of counterdispositional behavior

People enjoy acting extraverted, and this seems to apply equally across the dispositional introversion-extraversion dimension (Fleeson, Malanos, & Achille, 2002). It follows that dispositional introverts might improve their happiness by acting more extraverted, yet little research has examined potential costs of this strategy. In two studies, we assessed dispositions, randomly assigned participants to act introverted or extraverted, and examined costs-both emotional (concurrent negative affect) and cognitive (Stroop performance). Results replicated and extended past findings suggesting that acting extraverted produces hedonic benefits regardless of disposition. Positive affect increased and negative affect did not, even for participants acting out of character. In contrast, we found evidence that acting counterdispositionally could produce poor Stroop performance, but this effect was limited to dispositional extraverts who were assigned to act introverted. We suggest that the positive affect produced by introverts' extraverted behavior may buffer the potentially depleting effects of counterdispositional behavior, and we consider alternative explanations. We conclude that dispositional introverts may indeed benefit from acting extraverted more often and caution that dispositional extraverts may want to adopt introverted behavior strategically, as it could induce cognitive costs or self-regulatory depletion more generally.     

Synthesizing single-case studies: A Monte Carlo examination of a three-level meta-analytic model

Numerous ways to meta-analyze single-case data have been proposed in the literature; however, consensus has not been reached on the most appropriate method. One method that has been proposed involves multilevel modeling. For this study, we used Monte Carlo methods to examine the appropriateness of Van den Noortgate and Onghena's (2008) raw-data multilevel modeling approach for the meta-analysis of single-case data. Specifically, we examined the fixed effects (e.g., the overall average treatment effect) and the variance components (e.g., the between-person within-study variance in the treatment effect) in a three-level multilevel model (repeated observations nested within individuals, nested within studies). More specifically, bias of the point estimates, confidence interval coverage rates, and interval widths were examined as a function of the number of primary studies per meta-analysis, the modal number of participants per primary study, the modal series length per primary study, the level of autocorrelation, and the variances of the error terms. The degree to which the findings of this study are supportive of using Van den Noortgate and Onghena's (2008) raw-data multilevel modeling approach to meta-analyzing single-case data depends on the particular parameter of interest. Estimates of the average treatment effect tended to be unbiased and produced confidence intervals that tended to overcover, but did come close to the nominal level as Level-3 sample size increased. Conversely, estimates of the variance in the treatment effect tended to be biased, and the confidence intervals for those estimates were inaccurate.