Measuring Responsiveness in the Therapeutic Relationship: A Patient Perspective

This article reports results from a three-country study of patient perceptions of physician responsiveness. Based on existing research in the medical and social-psychological literatures, we theorized that patients' perceptions of physician responsiveness to their needs would be an important component of the patient–physician relationship and that this construct could be distinguished reliably from more global assessments of patient satisfaction. We then developed a new measure designed to assess these perceptions from the patients' point of view. This measure was administered to large samples of patients in the United States, the United Kingdom, and Canada. Results supported our hypotheses. Patient perception of physician responsiveness significantly predicted both patient satisfaction and subjective health-related problems, over and above effects attributable to general satisfaction. We also noted the absence of significant differences across the three cultures or sex, suggesting that the process we identify has considerable generality. We also describe a short version of our measure that researchers may find useful in a variety of research or clinical settings.     

Behavioral Skills Training With Teachers: Booster Training for Improved Maintenance

Behavioral skills training (BST) has been employed within many different populations for the reduction of problem behaviors and acquisition of new skills; however, these changes have not always maintained over time. This study evaluated the effects of a booster training for re-establishing the classroom management proficiencies that teachers had acquired previously, but had declined over a 12-month period. The single-subject experimental results showed the booster training to be effective in re-establishing teacher performance of skills as measured by both analogue role-play and in situ postassessments within the classroom. These findings suggest that a booster training utilizing BST may be an important strategy for maintaining skill performance over time.     

The Relationship Between Arousal and the Remembered Duration of Positive Events

The relation between affect and retrospective duration estimation has hardly been examined. In this paper, we contribute to filling this gap by studying the influence of arousal on the remembered duration of positive events. On the basis of the contextual change model, we expected that high‐arousal positive events would be remembered as longer compared with low‐arousal positive events. To test this hypothesis, we set up a naturalistic study in which participants were asked at the end of a pleasant amusement park ride at the local fair to rate how pleasant and aroused they felt during the ride as well as to estimate the ride's duration. Feeling more aroused during a ride was associated with longer estimates of the ride's duration. Results are discussed within the framework of retrospective time estimation models. Copyright © 2013 John Wiley & Sons, Ltd.     

Learning and Affect Following Near‐Miss Outcomes in Simulated Gambling

Gambling near‐misses are non‐rewarded events that resemble a winning configuration. Past research using slot machines has shown that moderate rates of near‐misses increase gambling persistence, but the mechanisms supporting this persistence are unclear. One hypothesis is that near‐misses are mistakenly interpreted as signals of skill acquisition, supporting learning and fuelling the ‘illusion of control’. A slot machine simulation was administered to 60 volunteers, with ratings of the perceived chances of winning, pleasure and motivation to play following particular outcomes. Psychophysiological measures (electrodermal activity and heart rate) were taken, and gambling persistence was measured after 30 trials. Near‐misses were similar to full‐miss outcomes in that they were regarded as unpleasant. However, near‐misses were akin to win outcomes in that they increased motivations to play and electrodermal activity. Learning was evidenced by the expectancy of winning increasing following wins and decreasing after losses. Although there was no overall change in expectancy of winning after near‐misses across all participants, those subjects reporting a greater increase in the expectancy of winning following a near‐miss showed more persistent play, consistent with the learning hypothesis. Greater heart rate acceleration following near‐misses was also associated with persistence. We also observed differential effects of near‐misses where the reel stopped either side of the winning position (‘payline’): motivational effects were restricted to near‐misses stopping before the payline, whereas near‐misses that stopped after the payline were primarily aversive. The payline effects are not predicted by the learning hypothesis and may indicate an affective component to near‐misses, possibly linked to counterfactual processing. Copyright © 2012 John Wiley & Sons, Ltd.     

Enhancing recovery rates: Lessons from year one of IAPT

BackgroundThe English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.MethodData from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).ResultsData completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.ConclusionsCompliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.     

Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

Prevalence,correlates, and psychosocial outcomes of sport participation in young adult cancer survivors

Young adult cancer survivors (YACS) face unique challenges from their disease and treatments that may influence their sport participation choices as well as their psychosocial response.ObjectivesTo examine the prevalence, correlates, and psychosocial outcomes of sport participation in YACS.DesignA provincial, population-based mailed survey of 588 YACS in Alberta, Canada, was completed in May 2008 and included measures of sport participation, psychosocial health (depression, self-esteem, and stress), quality of life (QoL), and medical and demographic variables.ResultsOne third (32.5%) of YACS reported participating in a sport in the past month with the most common being golf (40.8%) and ice hockey (8.3%). YACS participating in sport reported an average frequency of 1.7 (SD = 1.0) days/week and an average duration of 119 min/session (SD = 68) for a total of 189 (SD = 164) min/week. Independent t-tests showed that YACS who participated in sport reported better psychosocial health and QoL including physical QoL (p < 0.001), mental QoL (p < 0.001), self-esteem (p < 0.001), depression (p < 0.001), and stress (p < 0.001). In multivariate regression analysis, 8.5% (p < 0.001) of the variance in sport participation was explained by being male (β = 0.17, p < 0.001), Caucasian (β = 0.15, p = 0.001), in better general health (β = 0.15, p < 0.001), and having a normal body mass index (β = ?0.10, p = 0.024).Discussion/conclusionsSport participation is associated with better psychosocial health and QoL in YACS but only a third participated in the past month. Randomized controlled trials examining sport as an intervention strategy to increase physical activity and improve health outcomes in YACS are warranted.     

具有类属知识性的思维:群体区别判断过程中的复杂性、有效性、有用性和实质性

类属性思维(stereotypes)在一定的程度上是对群体区别正确反映的类属信仰.类属性思维比我们一般假想的更为复杂.首先,我们在本论文中探讨了在立体性的类属性思维EPA理论框架之下的多维度,即类属性思维的三维度:评估、激活和准确度.同时还特别讨论了类属性思维与具体集体共识的表征特点的图腾信仰之间的密切关系.其次,对于作为人类信仰一部分的类属性思维准确性莫衷一是的研究,我们进行了全面综述,并且本文还仔细考查文化类属性思维,个体类属性思维,个体与群体的判断,准确性评判的标准,和原分析的数据等等,同时进一步表明类属性思维和客观现实性有密不可分的关系.最后,我们指出类属性思维对解释群体和民族的区别非常重要,特别是人的感知的实质性寓于实在的客观群体本身(“感知的同一性”).我们认为,类属性思维的过程,对于高度的实体性和感知的实质性的群体来说,具有深刻影响,况且群体或部落(民族)的图腾也是其群体或民族的实体性的外在表现.尽管我们不可能解决同类属性思维的过程有关的所有争论,但我们所强调的观点是:类属性思维是人类相互影响和生存的有效类属性识别.     

The Role of Parenting in Relational Aggression and Prosocial Behavior among Emerging Adults

This study investigated the role of remembered parenting styles and parental psychological control in the prediction of relational aggression and prosocial behavior in a college student sample (N = 323). Participants’ retrospective ratings of how they were parented were related to relational aggression and prosocial behavior; however, somewhat different relationships emerged for African American and White participants. Permissive parenting, authoritative parenting, and parental psychological control predicted relational aggression. Participant race and all 3 parenting styles (authoritarian, authoritative, and permissive) predicted prosocial behavior. Participant race moderated the relationship between psychological control and prosocial behavior. Specifically, parental psychological control was inversely related to prosocial behavior for African American, but not White, participants.