Primary Care Providers’ Responses to Patient-Generated Family History

Family health history is one of the best predictors of an individual’s risk for common disease, yet it is underutilized in routine care. Although the Surgeon General has recommended consumers record their family health history and share it with their health care provider, providers’ perceptions of patient-generated family histories are unknown. To learn more about providers’ experience with and perceptions about patient-generated family histories, we mailed surveys to 301 providers and had a response rate of 24% (n = 68). Seventy-three percent felt a patient-generated computer pedigree would improve their ability to assess risk as compared to their current methods. Seventy percent felt a patient-generated computer pedigree would either have no effect on or would increase the number of patients that could be seen in a day. Results suggest that providers appreciate the potential benefits of patient-generated family histories. Genetic counselors and nurses are in a prime position to promote and facilitate the use of patient-generated family health histories in routine care.     

Moving beyond an exclusive focus on harm avoidance in obsessive compulsive disorder: considering the role of incompleteness

Cognitive-behavioral conceptualizations of obsessive compulsive disorder (OCD) have predominantly viewed compulsions as being motivated by harm avoidance. However, sensations of things being incomplete or not "just right" may also underlie compulsions in OCD. Preliminary research suggests that distinguishing between harm avoidance and incompleteness in OCD may have practical utility, but the research on this topic is very limited to date. The current study further addressed the role of incompleteness in OCD. A confirmatory factor analysis provided evidence for harm avoidance and incompleteness as separate constructs in a student sample. Supporting the benefits of considering incompleteness in addition to harm avoidance, self-reported levels of both constructs were significantly correlated with all domains of OCD symptoms and perfectionism assessed. Further, some evidence for unique relationships was found (e.g., incompleteness with ordering and personally prescribed perfectionism; harm avoidance with obsessing). The role of incompleteness in OCD warrants greater attention.     

Discriminative stimulus effects of diazepam and buspirone in normal volunteers.

A within-subject design was used to characterize the effects of dose manipulations on discriminative and self-reported effects of oral diazepam and buspirone. Subjects were trained to discriminate diazepam (10 mg) versus placebo (n = 10), or buspirone (10 or 15 mg) versus placebo (n = 9). The compounds were identified to subjects by letter code before discrimination training began. In later sessions, correct identifications at 2 hr after the oral administration of drug earned money. All subjects showed accurate discrimination performance during the test-of-acquisition phase. In a low-dose generalization phase, diazepam and buspirone produced dose-related increases in drug identifications across a four-fold range of doses. In a subsequent low-dose training phase, in which subjects were trained to discriminate progressively lower drug doses, the median lowest discriminable dose of diazepam and buspirone was 2.5 and 7.5 mg, respectively. Dose-response functions for drug identifications were shifted leftward in the low-dose training phase relative to the low-dose generalization phase, suggesting that reinforcement of progressively lower doses enhances drug discriminability. The self-reported effects of diazepam and buspirone were similar (e.g., both drugs increased ratings of drug strength and clumsy/uncoordinated) and different (e.g., diazepam but not buspirone increased ratings of drowsy/sleepy; buspirone but not diazepam increased ratings of tense/nervous). This study demonstrates discriminative and self-reported effects of diazepam and buspirone at doses lower than previously shown to be behaviorally active, and suggests that at commonly used clinical doses, diazepam is relatively more discriminable than buspirone.     

A Pilot Study of the Effects of Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder on Parenting

Parental posttraumatic stress disorder (PTSD) is associated with parenting difficulties. Cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD) improves PTSD symptoms, relationship adjustment, and partners’ mental health functioning. However, the impact of CBCT for PTSD on parenting competency is unknown. In this pilot study, the effects of CBCT for PTSD on parenting competency were investigated in 14 individuals (6 patients with PTSD and 8 partners) who had children under age 18. Results suggested that most participants perceived themselves as competent in their parenting prior to treatment, and some enhancements in competency occurred following CBCT for PTSD. Moreover, changes in parenting competency were associated with improvements in patient-rated PTSD. Adjunctive interventions targeting parenting and goals for future research are discussed.     

Audience with a Healer

Up From Scapegoating: Awakening Consciousness in Groups. 1995. By Arthur D. Colman Wilmette, IL: Chiron.

The Wounded Jung. (1996). By Robert C. Smith Evanston, IL: Northwestern University Press.

The Body: An Encyclopedia for Research in Archetypal Symbolism. 1996. By George R. Elder Boston: Shambhala.

Gifts of Suffering. 1996. By Polly Young-Eisendrath New York; Addison-Wesley Co.

The Religious Function of die Psyche. 1996. By Lionel Corbett London &; New York: Routledge.

Buddhism and the Art of Psychotherapy. 1996. By Hayao Kawai College Station, TX: Texas A &; M University Press.

The Soul's Code: In Search of Character and Calling. 1996. By James Hillman New York: Random House.

Kinds of Power A Guide to Its Intelligent Uses. 1995. By James Hillman New York: Doubleday.

Psychotherapy as a Mutual Process. 1996. By J. Marvin Spiegelman Tempe, AZ: New Falcon Publications.

Soul Cards. By Deborah Koff-Chapin 1995. Langley, WA: The Center for Touch Drawing.     

The benefits of anticipatory grief for the parents of dying children

Abstract

The authors develop a strategy for intervening into rigidly homeostatic systems. Central to the task is the identification of system rules, which often reveal themselves around “nodal themes.” The authors describe four types of nodal themes and offer clues to identifying them within families. Finally, they suggest ways of using system rules and nodal themes in the development of paradoxical interventions.     

A Deposit Contract Method to Deliver Abstinence Reinforcement for Cigarette Smoking

Eight smokers were randomly assigned to a deposit contract ($50.00) or to a no-deposit group. Using a reversal design, participants could recoup their deposit (deposit group) or earn vouchers (no-deposit group) for smoking reductions and abstinence (breath carbon monoxide [CO] ≤ 4 parts per million) during treatment phases. Treatment was delivered via a novel Internet-based method to monitor smoking status. Although equivalent decreases in breath CO and abstinence were observed during treatment in both groups, $178.50 in vouchers were distributed to participants in the no-deposit group, whereas a small surplus remained in the deposit group. A deposit contract method may represent a cost-effective model to deliver abstinence reinforcement for cigarette smoking.     

Concurrent schedules of positive and negative reinforcement: differential-impact and differential-outcomes hypotheses

Considerable evidence from outside of operant psychology suggests that aversive events exert greater influence over behavior than equal-sized positive-reinforcement events. Operant theory is largely moot on this point, and most operant research is uninformative because of a scaling problem that prevents aversive events and those based on positive reinforcement from being directly compared. In the present investigation, humans' mouse-click responses were maintained on similarly structured, concurrent schedules of positive (money gain) and negative (avoidance of money loss) reinforcement. Because gains and losses were of equal magnitude, according to the analytical conventions of the generalized matching law, bias (log b (double dagger) 0) would indicate differential impact by one type of consequence; however, no systematic bias was observed. Further research is needed to reconcile this outcome with apparently robust findings in other literatures of superior behavior control by aversive events. In an incidental finding, the linear function relating log behavior ratio and log reinforcement ratio was steeper for concurrent negative and positive reinforcement than for control conditions involving concurrent positive reinforcement. This may represent the first empirical confirmation of a free-operant differential-outcomes effect predicted by contingency-discriminability theories of choice.     

Informative Disagreements: Associations Between Relationship Distress,Depression, and Discrepancy in Interpersonal Perception Within Couples

This study evaluated the associations between relationship distress, depression symptoms, and discrepancy in interpersonal perception within couples. After completing a series of discussion tasks, couples (N = 88) rated their behavior using the circumplex‐based Structural Analysis of Social Behavior Model (SASB; Benjamin, 1979, 1987, 2000). Overall, couple members were strikingly similar in their interpersonal perceptions, and tended to see themselves as friendly, reciprocal in their focus, and balanced between connection and separateness. As hypothesized, however, perceptual discrepancy was related to relationship distress and depression. Relationship distress was associated with discrepancy regarding transitive behavior focused on the partner, while depression was associated with disagreement about intransitive, self‐focused behavior. Analysis of affiliation and autonomy revealed that relationship distress was associated with seeing oneself as reacting with more hostility than the partner sees, and perceiving one's partner as more hostile, more controlling, and less submissive than he or she does. Partners of depressed individuals viewed themselves as more controlling than their mate did. Men's depression was associated with disagreement between partners regarding men's self‐focused behavior. Results underscore the importance of considering interpersonal perception when conceptualizing relationship distress and depression within intimate relationships.