When the risks are low: the impact of absolute and comparative information on disturbance and understanding in US and UK samples

When Klein, W. M. gave participants absolute and comparative risk information (crossed experimentally) they were more disturbed by being above than below average, but not by being at higher rather than lower risk. The current experiment tests whether Klein's findings extend to situations involving lower risk figures more typical of genuine health risks, assesses participants’ understanding of the information, and directly compares responses of US and UK samples. Participants were presented with hypothetical information about comparative and absolute risks of deep vein thrombosis. There was a main effect of absolute risk information on disturbance and precaution intentions in the US sample, but no effects of comparative information on these measures in either sample. Understanding was poor among participants receiving both pieces of risk information. Future studies should include measures of understanding to establish whether people are failing to understand what they are told or failing to respond systematically to what they understand. Practically, the findings caution against providing comparative risk information when communicating low risk figures.     

Psychometric Support for an Abbreviated Version of the Behavior Rating Inventory of Executive Function (BRIEF) Parent Form

The objectives of this study were to systematically develop and evaluate the psychometric properties of an abbreviated version of the Behavior Rating Inventory of Executive Function (BRIEF) Parent Report; a questionnaire widely used by pediatric neuropsychologists. A total of 24 items from the original BRIEF Parent Form were selected for the short-form, which was then evaluated in three complementary samples, according to six a priori psychometric criteria. The short-form generally demonstrated appropriate psychometric qualities, with convincing evidence for the reliability and validity of the three composite indices: Behavioral Regulation, Metacognition, and the Global Executive Composite. Potential clinical applications include screening at-risk children in medical clinics to facilitate appropriate referrals for further psychological consultation. In research settings, the short-form can be easily integrated into studies involving mass collection of data (e.g., large-scale epidemiological research), facilitating advancements in the scientific understanding of neuropsychological morbidity in medically involved populations.     

Assessment and Development of Executive Function (EF) During Childhood

This review paper outlines the issues associated with the assessment of executive function (EF) in children and adolescents, and describes the developmental profile of executive processes across childhood. At the outset, EF is defined, and cognitive and behavioral impairments associated with executive dysfunction (EDF) are described. A developmental model of EF is proposed incorporating four discrete but inter-related executive domains (attentional control, cognitive flexibility, goal setting, and information processing) which operate in an integrative manner to enable “executive control”. Characteristics that constitute traditional EF measures are discussed, as are the problems associated with test interpretation. The ecological validity of EF tests and neuropsychological assessment procedures are examined, and adjunct methods of measurement are presented to enable a more comprehensive and valid assessment of EF. Based on developmental and normative studies, the maturation of executive domains is mapped. Attentional control appears to emerge in infancy and develop rapidly in early childhood. In contrast, cognitive flexibility, goal setting, and information processing experience a critical period of development between 7 and 9 years of age, and are relatively mature by 12 years of age. A transitional period is thought to occur at the beginning of adolescence, and shortly after “executive control” is likely to emerge. In order to confirm our current understanding of EF development and further enhance our understanding of brain-behavior relationships, longitudinal studies incorporating structural and functional neuroimaging are required.     

Neutron and X-ray diffraction studies and cohesive interface model of the fatigue crack deformation behavior

The crack-tip deformation behavior during a single overload, fatigue test of ferritic stainless steel, and Ni-based HAYNES 230 superalloy is studied at different structural levels using (1) neutron-diffraction, from which both the elastic-lattice strain and volume-averaged total dislocation densities are obtained, (2) polychromatic X-ray microdiffraction to probe the geometrically necessary dislocations and boundaries distribution, and (3) an irreversible and hysteretic cohesive interface model which has been implemented into a finite element framework to simulate the stress/strain evolution near the fatigue crack tip. Neutron strain measurements and finite element simulations are in qualitative agreement on the macroscopic length scale. Large plastic deformation induced by the overload and the resulting compressive residual strains are observed in front of the crack tip after the overload, and are the principal reason for the fatigue-crack-growth retardation. Strong strain gradients surrounding the crack propagation result in the formation of a high density of geometrically necessary dislocations near the fractured surface and cause local lattice rotations on the submicron level.     

Collective contributions to career efficacy in adolescents: A cross-cultural study

This study extended the concept of collective efficacy to supplement the variable of career self-efficacy to predict vocational exploration and commitment among adolescents. We developed a Collective Contributions to Career Efficacy Scale (CCCE) to measure adolescents' perceived contributions from parents, teachers, and peers on their career-related matters. A total of 1175 high school students from Hong Kong, Shanghai and Michigan participated in the study by completing the CCCE, the Career Decision Self-Efficacy Scale (CDSE-SF), and the Vocational Exploration and Commitment Subscale (VEC). Using multi-sample Structural Equation Modeling, we found that the effect of CCCE on VEC was mediated by CDSE. Although we found cultural differences in the overall level of the vocational measures among the Hong Kong, Shanghai, and American students, the mediation model was confirmed in all three groups of students.     

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.