Goal disturbance,coping, and psychological distress in partners of myocardial infarction patients: Taking account of the dyad

Abstract

This study aims to explore the relationship between goal disturbance and levels of psychological distress in partners of myocardial infarction (MI) patients. Furthermore, the role of partner and patient coping behaviour in the context of goal disturbance is explored. Forty dyads were interviewed and completed questionnaires 1 month (T1) and 4 months (T2) post MI. All patients were men. Patients and partners do not differ on anxiety or depression scores, however, patients experience significantly more higher order goal disturbance at T1. Partners reporting more goal disturbance also show increased distress at T1. More use of approach coping by partners contributes to explained variance in their goal disturbance. Partner avoidant coping is moderated by patient avoidant coping. Approaches to reduce distress in partners should thus take account of goal disturbance and coping behaviours within the dyad.     

Repeated retrieval practice and item difficulty: Does criterion learning eliminate item difficulty effects?

A wealth of previous research has established that retrieval practice promotes memory, particularly when retrieval is successful. Although successful retrieval promotes memory, it remains unclear whether successful retrieval promotes memory equally well for items of varying difficulty. Will easy items still outperform difficult items on a final test if all items have been correctly recalled equal numbers of times during practice? In two experiments, normatively difficult and easy Lithuanian–English word pairs were learned via test–restudy practice until each item had been correctly recalled a preassigned number of times (from 1 to 11 correct recalls). Despite equating the numbers of successful recalls during practice, performance on a delayed final cued-recall test was lower for difficult than for easy items. Experiment 2 was designed to diagnose whether the disadvantage for difficult items was due to deficits in cue memory, target memory, and/or associative memory. The results revealed a disadvantage for the difficult versus the easy items only on the associative recognition test, with no differences on cue recognition, and even an advantage on target recognition. Although successful retrieval enhanced memory for both difficult and easy items, equating retrieval success during practice did not eliminate normative item difficulty differences.     

Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance

One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from 2 clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. We highlight unique challenges in working with counselors unaccustomed to traditional clinical supervision. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted 1 year following implementation, and interviews with key organization executives and administrators.     

EPISTEMOLOGICAL ORIGINS–EPISTEMOLOGICAL AIMS: RETHINKING POSTMODERN THERAPY IN RESPONSE TO HELD

There has been a great deal of controversy over Barbara Held's use of the term "antirealism" in her now popular critique of postmodern therapy. Many of her respondents have rejected this label, claiming that it restricts the debate and oversimplifies their position. Recognizing that this is so, I nevertheless accept Held's term as a useful signifier of the epistemological framework of postmodern therapy, and, thus, challenge her critique on its own grounds. I argue that Held's critique of this epistemological approach, in fact, misses the epistemological point, targeting ontological issues where there are none, and misinterpreting the original aim behind the shift to epistemological antirealism. It is Held's contention that the antirealist turn aimed at "maximizing individuality" in therapy - a goal which can and should be achieved through realism. Her justification for the latter is a supposed "oscillation" between realism and antirealism in the theory of this movement. To the contrary, l suggest that the aim of this epistemological shift was the resolution of strictly epistemological problems, and that the oscillation that Held identifies is the product of her own conflation of epistemological and ontological issues.     

Deliberate Self-Harm and State Dissociation: An Experimental Investigation

The purpose of this study was to test the relation between deliberate self-harm (DSH) and state dissociation. Participants (N = 85) were randomly assigned to self-administer either a very mild electric shock below their pain threshold (a no-self-harm control condition) or an electric shock they were told could “cause minor tissue damage that would heal quickly,” but which was in fact equal to a predetermined pain threshold (a DSH condition). After task completion, 42 participants rated the extent of their dissociation before the shock and 43 rated the extent of their dissociation after the shock. Results indicated that women in the DSH group experienced more dissociation compared to men, but only after the shock. Potential reasons for this gender effect are discussed.     

Effects of religious stigma and harm on perceived psychopathology

Prior research suggests that assessment of the pathology of religious beliefs is influenced by conventionality and harm, with less conventional and more harmful beliefs resulting in higher pathology ratings. This study, involving 313 participants, investigated levels of pathology assigned to religious beliefs when the beliefs were either helpful or less severely harmful than those used in prior research, and when the associated religion was either stigmatised (Islam) or non-stigmatised (Christianity). Results indicate that an attenuated form of harm results in elevated pathology ratings. Furthermore, religious stigma impacts these perceptions when beliefs are harmful but not when beliefs are helpful. Ratings in the harm condition were higher for Christianity than for Islam, suggesting that perceived pathology of religious beliefs may depend less on general stigma assumptions and more on perceived consistency between harmful beliefs and assumed religious schemata.     

The moral psychology of rationing among physicians: the role of harm and fairness intuitions in physician objections to cost-effectiveness and cost-containment

Introduction

Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.

Methods

We mailed an 8-page survey to a random sample of 2000 practicing U.S. physicians. The survey included the MFQ30 and items assessing agreement/disagreement with cost-containment and degree of objection to using cost-effectiveness data to guide care. We used t-tests for pairwise subscale mean comparisons and logistic regression to assess associations with agreement with cost-containment and objection to using cost-effectiveness analysis to guide care.

Results

1032 of 1895 physicians (54%) responded. Most (67%) supported cost-containment, while 54% expressed a strong or moderate objection to the use of cost-effectiveness data in clinical decisions. Physicians who strongly objected to the use of cost-effectiveness data had similar scores in all five of the foundations (all p-values?>?0.05). Agreement with cost-containment was associated with higher mean “harm” (3.6) and “fairness” (3.5) intuitions compared to “in-group” (2.8), “authority” (3.0), and “purity” (2.4) (p?<?0.05). In multivariate models adjusted for age, sex, region, and specialty, both “harm” and “fairness” were significantly associated with judgments about cost-containment (OR?=?1.2 [1.0-1.5]; OR?=?1.7 [1.4-2.1], respectively) but were not associated with degree of objection to cost-effectiveness (OR?=?1.2 [1.0-1.4]; OR?=?0.9 [0.7-1.0]).

Conclusions

Moral intuitions shed light on variation in physician judgments about cost issues in health care.

     

提取练习在记忆保持与迁移中的优势效应：基于认知负荷理论的解释

提取练习比建构概念图更有利于记忆保持和迁移的研究结果尚存在争议。依据认知负荷的3个成分,设计两个实验探究前期知识水平与策略复杂性对以上两种学习策略有效性的影响。结果表明：(1)前期知识水平的主效应不显著,但是与学习策略之间存在交互作用：在提取练习策略条件下,高前期知识水平的被试与低前期知识水平的被试在记忆保持和迁移上的正确率没有显著差异,但是在建构概念图策略条件下,高前期知识水平的被试在记忆保持和迁移上的正确率显著地高于低前期知识水平的被试;(2)当降低概念图的难度后,被试使用建构部分概念图策略产生的认知负荷与使用提取练习策略相比显著降低,并且其在学习阶段学习到的知识量显著地高于使用提取练习策略的结果,但是在最终测试上,其记忆保持与迁移的正确率与使用提取练习策略并没有显著差异,策略的复杂性增加了学习者的额外负荷,但是对策略有效性的发挥却不具有决定性影响。以上结果说明提取练习策略之所以比建构概念图策略更具优势,不是因为其策略本身更易掌握,而是因为其与建构概念图策略相比不受学习者前期知识水平的影响。这意味着认知负荷理论可以很好地解释提取练习在记忆保持与迁移中产生优势效应的内部机制,并进一步证实提取练习与精细编码不同,具有独特的加工机制。     

Adults' representations of division facts: a consequence of learning history?

There has been a recent increase in the study of adults' performance on simple division problems. Researchers up to now have focused on the relationship between multiplication and division and have found that multiplication often has a mediating role in the solution of division problems (Campbell, 1997, 1999; LeFevre & Morris, 1999; Mauro, LeFevre, & Morris, 2002). In this study, division was exclusively examined to determine the strategies that are used to solve these problems and to identify factors relating to particular strategy use. Thirty-two participants were asked to solve two sets of 64 simple division problems (from 4 divided by 2 to 81 divided by 9) and error, latency, and strategy report data were collected. Fewer errors were made on easy problems, which were also solved more quickly than difficult problems. Participants used retrieval, multiplication, and other strategies to solve the problems and tended to use retrieval more on easy than difficult problems and used multiplication more on difficult problems than easy problems. Unexpected age differences in strategy use were also found. Older participants tended to rely more heavily on retrieval than younger participants. These results suggest that older participants may have stronger representations for simple division problems than younger participants.