Affect and emotions in placebo and nocebo effects: What do we know so far?

Once considered nuisance variance in clinical trials, placebo effects and nocebo effects are now widely recognized as important and mutable psychobiological contributors to mental and physical health. Psychological theory explaining these effects emphasizes associative learning and conscious expectations. It has long been suggested, however, that affective states such as moods, emotions, and distress could play a significant role. In this paper, we draw together and review the empirical data linking affective states to placebo and nocebo effects. To organize this disparate literature, three questions are addressed: (1) Does pre‐existing state and trait affect modulate placebo and nocebo effects? (2) Does administering placebo and nocebo treatments change affective states, and if so, does the resulting affect causally influence placebo and nocebo effects? Finally, (3) Can placebo treatments be successfully employed as a regulation strategy to modulate different affective states? In reviewing the evidence in relation to these three questions, it is clear that affect does play a key role in placebo and nocebo effects in many circumstances, and further, there may be a reciprocal dynamic at play between a treatment event, affect, and placebo/nocebo effects. The paper concludes by discussing implications for theory and intervention and recommends future research priorities.     

A review of attachment-based parenting interventions: Recent advances and future considerations

Research evidence has shown that in childhood, a secure attachment to a reliable caregiver is important for future mental health and well-being. The theoretical and research basis for attachment theory continues to grow. As attachment theory has become more widely adopted there are challenges and opportunities both theoretically and in terms of its clinical use. Disordered attachment has been linked to psychopathology including internalising and externalising disorders. However, there are ongoing implications for researchers and clinicians as only the most extreme forms of attachment disorders are included in the current diagnostic systems. A wide range of reliable and validated observational assessments to classify attachment are available. Owing to the growing popularity of attachment-based interventions there is a need to develop assessments which are practical for use in clinical settings. The use of attachment-based parenting interventions in clinical settings is increasing as they have been found to be effective and relevant. This growth presents opportunities to further refine these interventions, so they are easy to deliver in clinical practice and tailored to different populations. Attachment-based interventions are being widely used in Australia, and this has led to a need to understand and adapt the theory, assessments, and interventions to this context. Attachment-based interventions demonstrate the importance of relationships and provide an important tool to support children and families. For psychologists here in Australia there are many opportunities to develop measures and interventions based on attachment theory that fit into the Australia context.     

From “4Rs and 2Ss” to “Amaka Amasanyufu” (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context

In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children’s drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.     

Evaluation of a finger prompt variation in the treatment of pediatric feeding disorders

Children with feeding disorders often engage in refusal behavior to escape or avoid eating. Escape extinction combined with reinforcement is a well-established intervention to treat food refusal. Physical guidance procedures (e.g., jaw prompt, finger prompt) have been shown to increase food acceptance and decrease inappropriate mealtime behavior when more commonly employed escape extinction (e.g., nonremoval of the spoon) procedures are ineffective. The finger prompt, however, has not been extensively evaluated as a treatment adjunct to target food refusal, thus necessitating further examination. The purpose of this prospective study was to assess a variation of a finger prompt procedure to treat food refusal and to assess caregivers' acceptability of the procedure. Three children age 1 to 4 years admitted to an intensive feeding disorders program and their caregivers participated. The finger prompt was effective in increasing bite acceptance across all participants and decreasing or maintaining low levels of inappropriate behavior for 2 participants. The procedure was also acceptable to all caregivers.     

An analysis of the value of token reinforcement using a multiple-schedule assessment

Token systems are widely used in clinical settings, necessitating the development of methods to evaluate the reinforcing value of these systems. In the current paper, we replicated the use of a multiple-schedule reinforcer assessment (MSA; Smaby, MacDonald, Ahearn, & Dube, 2007) to evaluate the components of a token economy system for 4 learners with autism. Token systems had reinforcing value similar to primary reinforcers for 2 of the 4 learners, but resulted in lower rates of responding than primary reinforcers for the other 2 learners. Differentiated responding across learners may warrant variation in clinical recommendations on the use of tokens. The results of this study support formal assessment of token system effectiveness, and the MSA procedure provides an efficient method by which to conduct such assessments.     

Does Religious Activity Distinguish the Mortality Experiences of Older Taiwanese? An Analysis Using Eighteen Years of Follow-Up Data

This paper extends investigation of religiosity and longevity to Taiwan using a 1989 survey: N = 3849, aged 60+, with 18 years of follow-up. Religious activity is measured as worship and performance of rituals. A Gompertz regression, adjusted and non-adjusted for covariates and mediating factors, shows the hazard of dying is lower for the religiously active versus the non-active. Transformed into life table functions, a 60-year-old religiously active Taiwanese female lives more than 1 year longer than her non-religious counterpart, ceteris paribus. Mainland Chinese migrants are examined carefully because of unique religious and health characteristics. They live longer, but the religiosity gap is similar.

     

Towards Including End-Users in the Design of Prosthetic Hands: Ethical Analysis of a Survey of Australians with Upper-Limb Difference

Science and Engineering Ethics - Advances in prosthetic design should benefit people with limb difference. But empirical evidence demonstrates a lack of uptake of prosthetics among those with limb...