Physician Communication Coaching: How Psychologists can Elevate Skills and Support Resident Education,Professionalism, and Well-being

Journal of Clinical Psychology in Medical Settings - Many factors influence resident physician communication, including rigorous training demands that can contribute to professionalism issues or...     

Increasing Vegetable Consumption in Students with Autism Spectrum Disorder Using Pre-meal Presentation: A Preliminary Analysis

This study examined the effect of pre-meal presentation on the consumption of vegetables in a sample of 16 students with autism spectrum disorder (ASD). These 16 students (75% male; mean age?=?13 years; age range 8–18 years) were enrolled in a private school serving children with autism. School staff offered participants 10 small pieces of two vegetables during lunch (baseline) or prior to lunch (pre-meal presentation). Observers recorded the number of bites students consumed. We used an A–B–A–B design to examine the effects of pre-meal presentation. Results were evaluated using a mixed-method, individual- and group-level, analysis. Pre-meal presentation resulted in increased vegetable consumption for 9 of the 16 participants. A reversal to baseline demonstrated expected decreases in bites consumed, and the subsequent return to intervention demonstrated expected increases in bites consumed. One-way repeated measures ANOVA compared bites consumed per session across 10 four-session study blocks and found significant differences between these two conditions. Paired comparisons revealed no change in bites consumed per session from baseline to intervention block #1, but significant increases from baseline to intervention #2 and all subsequent intervention blocks. Our results suggested pre-meal presentation can serve as a low-cost, low-effort intervention for increasing vegetable consumption for some children with ASD.

     

Effects of stress and motivation on performing a spatial task

Learning is ubiquitous in the animal kingdom but has been studied extensively in only a handful of species. Moreover, learning studied under laboratory conditions is typically unrelated to the animal's natural environment or life history. Here, we designed a task relevant to the natural behavior of male African cichlid fish (Astatotilapia burtoni), to determine if they could be trained on a spatial task to gain access to females and shelter. We measured both how successfully animals completed this task over time and whether and how immediate early gene and hormone expression profiles were related to success. While training fish in a maze, we measured time to task completion, circulating levels of three key hormones (cortisol, 11-ketotestosterone, and testosterone) and mRNA abundance of seven target genes including three immediate early genes (that served proxies for brain activity) in nine brain regions. Data from our subjects fell naturally into three phenotypes: fish that could be trained (learners), fish that could not be trained (non-learners) and fish that never attempted the task (non-attempters). Learners and non-learners had lower levels of circulating cortisol compared to fish that never attempted the task. Learners had the highest immediate early gene mRNA levels in the homologue of the hippocampus (dorsolateral telencephalon; Dl), lower cortisol (stress) levels and were more motivated to accomplish the task as measured by behavioral observations. Fish that never attempted the task showed the lowest activity within the Dl, high stress levels and little to no apparent motivation. Data from non-learners fell between these two extremes in behavior, stress, and motivation.     

Effects of modality on the neural correlates of encoding processes supporting recollection and familiarity

Prior research has demonstrated that the neural correlates of successful encoding ("subsequent memory effects") partially overlap with neural regions selectively engaged by the on-line demands of the study task. The primary goal of the present experiment was to determine whether this overlap is associated solely with encoding processes supporting later recollection, or whether overlapping subsequent memory and study condition effects are also evident when later memory is familiarity-based. Subjects (N = 17) underwent fMRI scanning while studying a series of visually and auditorily presented words. Memory for the words was subsequently tested with a modified Remember/Know procedure. Auditorily selective subsequent familiarity effects were evident in bilateral temporal regions that also responded preferentially to auditory items. Although other interpretations are possible, these findings suggest that overlap between study condition-selective subsequent memory effects and regions selectively sensitive to study demands is not uniquely associated with later recollection. In addition, modality-independent subsequent memory effects were identified in several cortical regions. In every case, the effects were greatest for later recollected items, and smaller for items later recognized on the basis of familiarity. The implications of this quantitative dissociation for dual-process models of recognition memory are discussed.     

Improving the Transportability of CBT for Internalizing Disorders in Children

Research provides strong support for the efficacy and effectiveness of cognitive behavioral therapy (CBT) for the treatment of childhood internalizing disorders. Given evidence for limited dissemination and implementation of CBT outside of academic settings, efforts are underway to improve its transportability so that more children with mental health needs may benefit from treatment. Creative modifications to existing treatments aim to deliver CBT for anxiety disorders and depression in a more transportable format. Notable progress has been made within the areas of computerized CBT, camp-based CBT, school-based CBT, and CBT delivered through primary care settings. These approaches are discussed within the context of key elements of transportability that are particularly germane to the dissemination and implementation of child treatments.     

Attachment Anxiety, Verbal Immediacy, and Blood Pressure: Results from a Laboratory-Analogue Study Following Marital Separation

Marital separation and divorce increase risk for all-cause morbidity and mortality. Using a laboratory analogue paradigm, the present study examined attachment anxiety, language use, and blood pressure (BP) reactivity among 119 (n = 43 men, 76 women) recently separated adults who were asked to mentally reflect on their relationship history and separation experience. We created a language use composite of verbal immediacy from participants' stream-of-consciousness recordings about their separation experience as a behavioral index of attachment-related hyperactivation. Verbal immediacy moderated the association between attachment anxiety and BP at the beginning of a divorce-specific activation task. Participants reporting high attachment anxiety who discussed their separation in a first-person, present-oriented and highly engaged manner evidenced the highest levels of BP at the start of the divorce-specific task. Results provide a deeper understanding of the association between marital dissolution and health and suggest that verbal immediacy may be a useful behavioral index of hyperactivating coping strategies.     

Extended Family Impact of Genetic Testing: The Experiences of X-linked Carrier Grandmothers

In many cases, X-linked conditions are transmitted through families “silently” until the first affected individual is diagnosed. Grandmothers are often then tested to help determine the risk to other family members. To date, psychosocial research on carriers of X-linked conditions has focused primarily on mothers and sisters of affected males. In the wider social science literature, studies on grandparents of children with disabilities have centered on their role within the family and relationship with the grandchild. We therefore know little about the impact of carrier testing for a genetic condition on grandparents. This qualitative study aims to contribute towards filling that gap. This study included thirteen grandmothers in families with Fragile X or Duchenne muscular dystrophy; ten had living affected grandsons and three had daughters who chose not to continue with affected male pregnancies after prenatal diagnosis. All thirteen took part in semi-structured interviews and provided a rich and varied data source for conducting thematic analysis. Most of the grandmothers expressed recurring feelings of guilt and a strong sense of responsibility for what had occurred in the family. Other themes included feelings of shock after receiving their test result, changes in family relationships and searching to make sense of the inheritance within the context of the family’s experience. This study provides evidence that X-linked carrier testing can have a profound and lasting impact on grandmothers. Although genetic counseling for X-linked conditions is often focused on the potential reproductive implications for carriers, these findings suggest that grandmothers should also be offered genetic counseling when tests are carried out, because of the likely psychosocial impact of a positive test result.     

Familism, family environment, and suicide attempts among Latina youth

In this study, we examined the relationship between familism and family environment type as well as the relationship between family environment type and suicide attempts among Latina youth. Latina teen attempters (n = 109) and nonattempters (n = 107) were recruited from the New York City area. Latent class analysis revealed three family environment types: tight-knit, intermediate-knit, and loose-knit. Tight-knit families (high cohesion and low conflict) were significantly less likely to have teens who attempted suicide as compared with intermediate-knit families or loose-knit families. Moreover, familism increased the odds of being in a tight-knit family versus a loose-knit family and the odds of being in a tight-knit family versus a intermediate-knit. The results suggest that familism may protect against suicide behavior among Latinas via its influence on family environment.     

Predictors of Perceived Need for Medical Care in an Inpatient Rehabilitation Unit: An Update

Limited awareness of illness, or poor insight, has been associated with poor treatment outcomes and prognoses in both psychiatric and medical populations. We examined predictors of insight in a sample of 403 patients in an inpatient rehabilitation unit at a Midwest Veterans Affairs Medical Center. A multiple regression analysis revealed that age, depression, IQ, and a measure of judgment were significant predictors of acknowledgement of illness. Younger age, higher IQ, better judgment, and depression were associated with better insight. By identifying risk factors for poor insight, these findings have significant clinical implications for healthcare providers.