Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy

Despite the major advances in the development of treatments for bulimia nervosa, drop-outs and a lack of engagement in treatment, continue to be problems. Recent studies suggest that the transtheoretical model of change may be applicable to bulimia nervosa. The aim of this study was to examine the roles of readiness to change and therapeutic alliance in determining engagement and outcome in the first phase of treatment. One hundred and twenty five consecutive female patients meeting DSM-IV criteria for bulimia nervosa took part in a randomised controlled treatment trial. The first phase of the sequential treatment compared four sessions of either cognitive behavioural therapy (CBT) or motivational enhancement therapy (MET) in engaging patients in treatment and reducing symptoms. Patients in the action stage showed greater improvement in symptoms of binge eating than did patients in the contemplation stage. Higher pretreatment scores on action were also related to the development of a better therapeutic alliance (as perceived by patients) after four weeks. However, pretreatment stage of change did not predict who dropped out of treatment. There were no differences between MET and CBT in terms of reducing bulimic symptoms or in terms of developing a therapeutic alliance or increasing readiness to change. The results suggest that the transtheoretical model of change may have some validity in the treatment of bulimia nervosa although current measures of readiness to change may require modification. Overall, readiness to change is more strongly related to improvement and the development of a therapeutic alliance than the specific type of treatment.     

Pathways of Economic Influence on Adolescent Adjustment

An important part of a science aimed at the prevention of human dysfunction involves the development of empirically based models that identify processes of risk for or protection from emotional distress or behavioral problems over time. The present study developed and evaluated such a model that proposed two pathways through which family economic pressure was expected to influence change in adolescent internalizing symptoms (depression and anxiety) during the period from the eighth to the tenth grades. A total of 377 rural families in a midwestern state provided data for the analyses. The results were generally consistent with the conceptual model in that family economic pressure increased adolescent perceptions of family economic hardship, which, in turn, reduced the adolescent's sense of control or mastery over time. Lowered mastery was associated with increases in emotional distress. Also consistent with the model, prior levels of mastery appeared to reduce the magnitude of economic stress experienced by the adolescent, whereas prior emotional distress intensified the economic stress process. Although gender differences were found in these processes, the overall pattern of results suggests that girls and boys are both at risk for internalizing problems when families experience economic pressure. Implicatios of the findings for the dvelopment of effective preventive interventions with financially stressed families in rural areas are discussed.     

Does contextual strength modulate the subordinate bias effect? A reply to Kellas and Vu

In their reply to Binder and Rayner (1998), Kellas and Vu (1999) raised questions about the criteria we used to exclude items from the Kellas, Martin, Yehling, Herman, and Vu (1995) stimulus set. In this reply, we further document these criteria and also address the issue of local versus published norms. We continue to believe that the stimulus set used by Kellas et al. (1995) was problematic. We also address the issue of strength of context, a concept used in earlier research that dealt with the subordinate bias effect. We argue that the contexts used by Kellas et al. (1995) were no stronger than the contexts previously used that established this effect. Therefore, we continue to think that our finding that context does not eliminate the subordinate bias effect is valid.     

Case Report—Loyalty, Legacy, and Ledger: Contextual Therapy in a Patient with a Family History of Ovarian Cancer

A client's emotional experiences and reactions to those experiences are influenced by his/her family of origin and direct or indirect interactions with various family members. Contextual therapists propose that a client's satisfaction with a relationship depends on the equity of his/her emotional interactions with family members. When relationships are inequitable, trust between individuals disintegrates. In order to reestablish trust in a relationship, a balance of interests must be restored. If not, imbalances may be passed down to future generations. A case of a woman with a family history of ovarian cancer is reviewed with the principles of contextual therapy in mind. In her family, several legacies have resulted in unbalanced relationships between family members that lead to difficulty in establishing trust within the genetic counseling session.     

Rhetorical Unity and Social Division: A Longitudinal Study of Change in Australian Self-Stereotypes

This paper examines the impact of social division associated with the emergent "race debate" in Australia (and the so-called "Hanson phenomenon") on the consensus of Australian students' stereotypes of their national ingroup. It compares the stereotypes held by a sample of students in 1997 ( N = 20) with those revealed in studies conducted from 1992 onwards ( N = 102). Results provide strong evidence that stereotype consensus was reduced in the current phase of research and post-testing also indicates that participants themselves interpreted this as being the product of political change in Australian society. The findings are consistent with the argument that stereotypes are sensitive to changes in intergroup and intragroup relations, and that they respond to the reality of social division rather than to the rhetoric of unity.     

The myth of upright vision. A psychophysical and functional imaging study of adaptation to inverting spectacles

The adaptation to inverting prisms and mirror spectacles was studied in four subjects over periods of six to ten days. Subjects showed rapid adaptation of visuomotor functions, but did not report return of upright vision. The persistence of the transformed visual image was confirmed by the subjects' perception of shape from shading. No alteration of the retinotopy of early visual cortical areas was seen in the functional magnetic resonance images. These results are discussed in the context of previous claims of upright vision with inverting prisms and mirror spectacles.     

Recruitment and Retention of Low‐SES Ethnic Minority Couples in Intervention Research at the Transition to Parenthood

Low‐SES couples have limited resources to manage the chronic and acute stressors with which they are disproportionately faced. Although these couples are at greater risk for negative individual and relationship outcomes, evaluations of the impact of couple relationship education (CRE) in low‐SES couples have been plagued by methodological problems, most notably challenges associated with recruitment and retention. We review the literature on challenges couples face associated with low‐SES, as well as on recruitment, retention, and CRE in low‐SES, ethnic minority populations. We illustrate some of these challenges in a case study of CRE for low‐SES couples transitioning to parenthood. In this pilot study, 21 couples were recruited from a community health clinic and randomized to either an experimental treatment condition (EXP; N = 11) or a treatment‐as‐usual control condition (TAU; N = 10). This study sought to mitigate documented challenges with recruitment and retention: We leveraged community partnerships, attempted to build and maintain strong relationships with study participants, provided incentives for assessments as well as intervention meetings, and attempted to reduce potential barriers to enrollment and retention. Nonetheless, we had low rates of recruitment and retention. We integrate these findings and experiences with our review of previous work in this area. We make recommendations for future CRE research and practice that have potential implications for public policy in this area.     

Translating the ICAP Theory of Cognitive Engagement Into Practice

ICAP is a theory of active learning that differentiates students’ engagement based on their behaviors. ICAP postulates that I nteractive engagement, demonstrated by co‐generative collaborative behaviors, is superior for learning to C onstructive engagement, indicated by generative behaviors. Both kinds of engagement exceed the benefits of A ctive or P assive engagement, marked by manipulative and attentive behaviors, respectively. This paper discusses a 5‐year project that attempted to translate ICAP into a theory of instruction using five successive measures: (a) teachers’ understanding of ICAP after completing an online module, (b) their success at designing lesson plans using different ICAP modes, (c) fidelity of teachers’ classroom implementation, (d) modes of students’ enacted behaviors, and (e) students’ learning outcomes. Although teachers had minimal success in designing Constructive and Interactive activities, students nevertheless learned significantly more in the context of Constructive than Active activities. We discuss reasons for teachers’ overall difficulty in designing and eliciting Interactive engagement.     

Minority representation,tokenism, and well-being in army units

Racial and ethnic diversity is increasing in the US Army and women are moving into more combat roles. This puts minority soldiers at risk for being underrepresented in their work units. Tokenism theory predicts that when a work group has less than 15% representation in a social group, the numerically underrepresented minority (i.e., token) members are subject to three disadvantages: higher visibility, informal isolation, and role encapsulation. In the Army, where many companies contain small numbers of women and racial minorities, some soldiers may face additional stressors and constraints. We explored psychosocial, organizational, and health outcomes of all identifiable token women (N = 4,425) and Black soldiers (N = 5,040). Tokens were remarkably similar to non-tokens and majority soldiers on outcomes such as coping skills, adaptability, organizational trust, sleep, substance use, and pain. The intersection of token status in terms of race and gender was not related to any appreciable differences. One potential explanation is the shared Army culture that emphasizes group unity and the importance of the mission above individual characteristics and goals. The Army depends on cohesion, organizational identification, and commitment to the group in order to reduce stress and anxiety, and to maximize combat performance. For soldiers who have internalized this culture, it could be easier to see past individual differences such as gender and race and identify others in the unit as fellow soldiers primarily.