Illness representations predict adherence in adolescents and young adults with type 1 diabetes

Objective: Most adolescents and young adults (AYAs) with type 1 diabetes struggle with diabetes self-management and exhibit suboptimal glycemic control. This study examined two models of association between illness representations, a modifiable predictor of suboptimal outcomes, and adherence and glycemic control in AYAs with type 1 diabetes.

Design and main outcome measures: Ninety-nine AYAs (ages 15–20?years) completed measures of illness representations and adherence at two visits. Blood glucose monitoring frequency and haemoglobin A1c were obtained via chart review. Relationships were examined using structural equation modelling.

Results: Illness representations accounted for a significant proportion of the variance in blood glucose monitoring frequency (ΔR^2?=?.23, p?<?.01) and adherence to emergency precautions at Time 1 (ΔR^2?=?.07, p?=?.03). Illness representations also accounted for significant variance in blood glucose monitoring frequency (ΔR^2?=?.08, p?=?.01), adherence to recommendations for insulin and food (ΔR²?=?.08, p?=?.02) and exercise (ΔR^2?=?.10, p?<?.01), and adherence to emergency precautions (ΔR^2?=?.16, p?<?.01) at Time 2.

Conclusion: Illness representations are salient predictors of adherence in this population. Interventions targeting adherence promotion and glycemic control in AYAs with type 1 diabetes may be enhanced by efforts to modify illness representations.     

The Relationship Between Postdeployment Factors and PTSD Severity in Recent Combat Veterans

Combat traumas precipitate posttraumatic stress disorder (PTSD); however, nontraumatic deployment and postdeployment factors may also contribute to PTSD severity. The Deployment Risk and Resilience Inventory (DRRI) was used to investigate pre-, peri-, and postdeployment factors associated with current PTSD severity in 150 recent combat veterans with PTSD and hazardous alcohol use. Hierarchal linear regression analyzed what factors independently predicted PTSD severity when controlling for sociodemographic characteristics and combat specific variables. Four postdeployment factors independently predicted PTSD severity: unemployment, alcohol use, social support, and stressful (nontraumatic) life events. The centrality of trauma in the maintenance of PTSD and clinical implications for treatment providers are discussed.     

Therapeutic Assessment With Child Inpatients

Growing evidence supports Therapeutic Assessment (TA), a collaborative and therapeutic approach to psychological assessment, as an effective method for enhancing motivation for and engagement with psychotherapy across a variety of clinical populations and treatment settings. However, to date there are no known studies assessing the use of TA in child psychiatric inpatient settings. This article briefly reviews the structure of child and family TA, enumerates the challenges and risks associated with short-term inpatient stays, and proposes a path for integrating TA into these units as a way to enhance the quality of care and reduce the risk of rapid rehospitalization. The authors provide three case examples from a child psychiatric inpatient unit, each using a modified version of TA and each integrating assessments into brief family interventions. The authors conclude with suggestions for best practice for child psychiatric inpatient TAs.     

Reactive and Proactive Aggression in Childhood and Adolescence: Precursors, Outcomes, Processes, Experiences, and Measurement

ABSTRACT. This paper reviews and critiques the growing literature on the distinction between reactive and proactive aggression in children and adolescents. Empirical findings suggest that the subtypes of aggression are (a) preceded by different familial precursors, (b) associated with different behavioral outcomes, (c) driven by different social–cognitive and emotional processes, and (d) related to different social experiences. Because measurement difficulties have been a prominent concern in the study of reactive and proactive aggression, a discussion of various assessment approaches is included. Suggestions are made for future research directions, including a greater use of observational and laboratory-based methods, more longitudinal designs, and a greater focus on the careful assessment of the subtypes of aggression.     

Some things you should know about structural equation modeling but never thought to ask

Iacobucci (2009, 2010) covers a number of important issues in the use of structural equation modeling and in so doing provides researchers with many useful insights and sensible suggestions. This commentary focuses on three issues where our views differ somewhat from those expressed in the target articles: SEM and causal inferences, sample size, and model fit. In addressing each of these issues, our perspectives do not so much contradict the views expressed by Iacobucci as they reflect a somewhat different conceptual emphasis.     

Confrontation and Beyond: Examining a Stigmatized Target's Use of a Prejudice Reduction Strategy

What can stigmatized individuals do to reduce stereotyping, prejudice, and discrimination when they interact with a biased individual? This paper reviews the social psychological literature that examines how targets can be active agents of prejudice reduction for themselves and their group. The extant literature indicates that a target's direct confrontation of bias can reduce prejudice and discrimination against the target's group but that this strategy can also backlash in the form of increased prejudice and discrimination against the target. Other research indicates that presenting a common‐identity, self‐enhancing feedback, and a self‐affirmation can reduce bias against the target but that they may not reliably change bias against the target's group. We conclude by discussing the need for research on the processes by which stigmatized targets decide to use a given bias‐reduction strategy and on the processes by which specific strategies are effective, either alone or in combination, when delivered by a stigmatized target.     

Same-Sex Intimate Partner Violence: Lesbian,Gay, and Bisexual Affirmative Outreach and Advocacy

Intimate partner violence (IPV) is pervasive and crosses all boundaries of sexual orientation, race, and class. Scholars contend that the intimidation of another person through abusive acts and words is not a gender issue. Organizations seeking to offer equitable services to survivors of IPV must intentionally establish themselves as inclusive agencies. This article presents a review of common societal myths and barriers to help-seeking for survivors of same-sex partner violence and offers program guidelines for lesbian, gay, and bisexual affirmative outreach services and advocate training.     

Spirituality and Substance Abuse Recovery

Researchers explored patient and staff perceptions of spiritual well-being and the spiritual needs of patients enrolled in a residential substance abuse treatment program. The Spiritual Well-Being Scale was used to gather quantitative data. Additionally, a brief questionnaire containing one qualitative and two quantitative questions was completed by both clients and staff. A statistically significant difference was found, indicating a more positive sense of spiritual well-being among patients upon discharge. Although the staff and clients of the residential program have similar perceptions regarding the concept of spiritual well-being, their definitions do not appear identical.     

Reflecting on Six Decades of Selective Exposure Research: Progress,Challenges, and Opportunities

For over 60 years, researchers have explored the validity of the selective exposure hypothesis, which states that people will seek out consonant, and avoid dissonant, information. In early cognitive dissonance‐based research, selective exposure received mixed support. More recently, researchers have begun to delineate the factors that regulate the occurrence of selective exposure in a multitude of contexts. In this review, we discuss a number of such moderators as well as the ebb and flow of research over the years. We propose that many of these factors can be conceptualized as influencing capacity and/or motivations to process information, and we discuss how this framework can help categorize past, and suggest future, moderators. Finally, we highlight that other research domains should be considered when exploring selective exposure effects, and that researchers should consider how findings from the selective exposure literature can fruitfully be applied to other domains.     

Global and local evaluations of public speaking performance in social anxiety

Differences in the relative use of global and local information (seeing the forest vs. the trees) may explain why people with social anxiety often do not benefit from corrective feedback, even though they pay close attention to details in social situations. In the current study, participants high (n = 43) or low (n = 47) in social anxiety symptoms gave a series of brief speeches, and then self-rated their speaking performance on items reflecting global and local performance indicators (self-assessment) and also received standardized performance feedback from an experimenter. Participants then completed a questionnaire asking how they thought the experimenter would rate their performance based on the feedback provided (experimenter assessment). Participants completed the self- and experimenter assessments again after 3 days, in addition to a measure of postevent processing (repetitive negative thinking) about their speech performance. Results showed that, as hypothesized, the High SA group rated their performance more negatively than the Low SA group. Moreover, the High SA group's ratings of global aspects of their performance became relatively more negative over time, compared to their ratings of local aspects and the Low SA group's ratings. As expected, postevent processing mediated the relationship between social anxiety group status and worsening global performance evaluations. These findings point to a pattern of progressively more negative global evaluations over time for persons high in social anxiety.