Predicting premature termination within a randomized controlled trial for binge-eating patients

Understanding the dropout rates of efficacious forms of psychotherapy for patients with binge eating disorder (BED) is an unsolved problem within this increasing population. Up until now the role of psychotherapy process characteristics as predictors of premature termination has not been investigated in the BED literature. Within a randomized controlled trial (N=78) we investigated the degree to which early psychological process characteristics, such as components of the therapeutic relationship and the experiences of mastery and motivational clarification, predicted premature termination of treatment. We statistically controlled for the influences of covariates such as rapid response of treatment, treatment group, body mass index, Axis II disorder, and patients' preexisting generalized self-efficacy at baseline. Patients' postsession reports from Sessions 1 to 5 indicated that low self-esteem in-session experiences was a stable predictor of premature termination. Its predictive value persisted after controlling for the above-mentioned covariates. Exploratory analyses further revealed low self-esteem experiences, low global alliance, and low mastery and clarification experiences as predictors in those patients who explicitly specified discontentment with therapy as reason for premature termination. These results indicate that patients' self-esteem experiences may not be an epiphenomenon of their specific psychopathology but may represent general mechanisms on which remaining or withdrawing from psychotherapeutic treatment depends. Early psychotherapy process characteristics should therefore be considered in training and evaluation of psychotherapists carrying through BED treatments.     

Parenting of 7‐month‐old infants at familial risk for attention deficit/hyperactivity disorder

Patterns of interaction between parents and 7‐month‐old boys at familial risk for attention deficit/hyperactivity disorder (ADHD) and a comparison group were studied during a warm‐up and two play episodes. The sample included 78 (47 at‐risk, 31 comparison) mother–child and 45 (27 at‐risk, 18 comparison) father–child dyads. A coding system developed by G. Kochanska (1997, 1998) was used. Infants in the risk group did not differ from the comparison group in the rate of emission of infant‐related events. However, they received less adequate responsivity from both their fathers and their mothers to these events, and specifically to negative emotions or distress, than did the comparison group. Maternal psychopathology did not account for these findings. Mothers were more adequately responsive than were fathers, especially for physiological needs. The association between nonoptimal interaction in infancy and the development of ADHD is discussed.     

Sleep patterns of 7‐week‐old infants at familial risk for attention deficit hyperactivity disorder

Sleep patterns of 26 seven‐week‐old boys at familial risk for attention deficit hyperactivity disorder (ADHD) and 18 control infants were compared by objective (actigraph) and subjective (maternal sleep diary) measures, over five consecutive 24‐hr periods. Actigraph findings indicated that the groups differed on stability (SD) of quiet sleep only during the day. Reports in maternal sleep diaries indicated that they also differed on stability of waking and stability of sleep duration, again only during the day. No group differences were found in terms of average scores, whether calculated for the entire 24‐hr periods, for nights, or for days. Mothers in the risk group reported that fathers were less involved in infant care than did those in the control group. These findings suggest that as early as 7 weeks of age, infants at risk for ADHD differ from controls only on stability of their sleep patterns during the day, when environmental regulatory factors are more intensive.     

Wittgenstein's Philosophical Grammar: A Neglected Discussion of Vagueness

In this paper I explore a neglected discussion of vagueness put forward by Wittgenstein in his Philosophical Grammar (1932–34). In this work, unlike Philosophical Investigations (1953), Wittgenstein not only discusses the venerable Sorites paradox but provides a novel conception of vagueness using an analogy with coin tossing and converging intervals. As he sees it, the problematic picture of vagueness arises because we conflate aspects of the functioning of vague concepts with those of non‐vague ones. Thus, while we accept that vague concepts have no sharp cut‐off points (are boundaryless), we nevertheless retain the idea that we can progress towards the penumbra the way we progress towards the cut‐off points of non‐vague concepts. As a potential remedy, Wittgenstein's analogy with coin tossing and converging intervals replaces this picture and provides an understanding of the functioning of vague concepts in which no notion of a progression arises.     

Evidenzbasierte Psychotherapie der Depression

Depressive disorders are among the most frequent reasons for utilizing the health care system. Despite the availability of efficacious treatments and further advances throughout the last years, there is still a need for improving diagnostic and therapeutic procedures. A promising approach is the implementation of evidence- and consensus-based guidelines. The German “Nationale VersorgungsLeitlinie Unipolare Depression” are evidence- and consensus-based clinical practise guidelines for patients with unipolar depression. All relevant stakeholders have been involved in its development and have passed the final version at the end of 2009 to foster compliance throughout. The available evidence allows the derivation of differentiated treatment recommendations, also with regard to concomitant antidepressant medication or as alternative treatment options. In acute therapy watchful waiting over 14 days is recommended for mild depression and psychotherapy after persistence of symptoms. In cases of moderate depression, psychotherapy and pharmacotherapy are equally recommended, in cases of severe depression a combination of both is recommended.     

Bedside ethics and health system catastrophe: imagine if you will..

Preparations for large-scale disasters have tended to focus on triage schema, stockpiling of materials, and other logistical concerns. Less attention has been given to the myriad of distressing and almost unthinkable ethically charged dilemmas that will emerge at the bedside during a catastrophe, and how they may be best managed. Yet, it is these bedside issues that may limit or thwart the effectiveness of disaster planning, and, therefore, they ought to be carefully considered.     

Pandemic preparedness planning: will provisions for involuntary termination of life support invite active euthanasia?

A number of influential reports on influenza pandemic preparedness include recommendations for extra-autonomous decisions to withdraw mechanical ventilation from some patients, who might still benefit from this technology, when demand for ventilators exceeds supply. An unintended implication of recommendations for nonvoluntary and involuntary termination of life support is that it make pandemic preparedness plans vulnerable to patients' claims for assisted suicide and active euthanasia. Supporters of nonvoluntary passive euthanasia need to articulate why it is both morally different and morally superior to voluntary active euthanasia if they do not wish to invite expansion of end-of-life options during health system catastrophe.     

Predictors of verdict and punitive damages in high-stakes civil litigation

This research investigated demographic and attitudinal- psychological predictors of verdict and amount of punitive damages awarded in high-stakes civil litigation. Four hundred and forty-six surrogate jurors, selected to be representative of actual jurors, were exposed to realistic case presentations in insurance, tobacco, and pharmaceutical cases that were about to go to trial. Hierarchical regression revealed that perceptions of the existence of a litigation crisis predicted verdict in the tobacco and pharmaceutical cases after controlling for all other variables. Demographic variables predicted verdict and punitive damage awards only modestly and in different ways in the three cases. Need for cognition, strength of will and rationality, and a perception that there is a litigation crisis predicted the amount of punitive damages awarded in the tobacco case. Litigation crisis also predicted the amount of punitive damages awarded in the pharmaceutical case. Implications for jury selection are discussed.     

Von anderen Patienten lernen

Today, internet-based technologies are used at all levels of psychosocial services. Current psychotherapeutic applications concentrate on the implementation of traditional approaches in the internet. Self-help programs are posted onto the net, therapies are conducted via e-mail and groups meet in virtual chat rooms. If one looks at the development of the web over the last 2 years, it becomes clear that the substantial growth and popularity of this medium is due to internet platforms where contents and knowledge can be developed in collaborative environments and experiences can be shared with other users. The present paper addresses this development. On the basis of our example it is discussed how collaborative elements can be integrated into a psychotherapeutic application.