Exercise therapy for depression in middle-aged and older adults: predictors of early dropout and treatment failure.

Psychosocial factors predicting treatment dropout or failure to benefit from treatment were identified in a randomized trial of exercise therapy and pharmacotherapy for major depression. One hundred fifty-six men and women over age 50 diagnosed with major depressive disorder were assigned to a 16-week program of aerobic exercise, medication (sertraline), or a combination of exercise and medication. Thirty-two patients (21%) failed to complete the program and were considered treatment "dropouts." At the end of 16 weeks, 83 patients (53%) were in remission; the remaining patients not in remission were considered treatment "failures." Baseline levels of self-reported anxiety and lift satisfaction were the best predictors of both patient dropout and treatment success or failure across all treatment conditions.     

Underreporting of psychopathology on the MMPI-2: a meta-analytic review

Meta-analytic techniques were applied to studies of the MMPI-2 in which participants given standard instructions were compared with participants instructed or believed to have been underreporting. Traditional and supplementary indices of underreporting yielded a mean effect size of 1.25, suggesting that underreporting respondents differ from those responding honestly by a little more than 1 standard deviation, on the average, on these scales. Analyses of classification accuracy suggested that several scales are moderately effective in detecting underreporting, although accuracy decreases if participants have been coached about validity scales. Base rates of defensive responding in relevant populations are reviewed, and methodological issues, including research designs, coaching, and incremental validity of supplementary underreporting scales, are discussed.     

The Assessment of Hyperactivity and Attention (AHA): development and preliminary validation of a brief self-assessment of adult ADHD

A brief self-rating scale, the Assessment of Hyperactivity and Attention (AHA), was developed and validated using a "gold standard" DSM-based semi-structured interview. The sample consisted of 101 smokers (74% male, 73% Caucasian)-38.6% with no DSM-IV ADHD diagnosis, 10.9% with a childhood diagnosis only, and 50.5% with an adult diagnosis (requiring childhood diagnosis as well). The mean age SD was 33.7 9.7; participants smoked a mean of 19.0 5.6 cigarettes/day. Results indicate that the AHA has utility as a screening tool and as a self-report assessment of ADHD with sensitivity of .80, specificity of .60, positive predictive power of .67, negative predictive power of .75, kappa of .40, odds ratio of 6.15, and an area under the curve (receiver operating characteristic analysis) of .79. Given the high rate of ADHD among smokers, the AHA may be useful in identifying smokers who may need more in-depth clinical evaluation for attentional problems.     

If at first you don't succeed. False hopes of self-change

Despite repeated failure at attempts to change aspects of their behavior, people make frequent attempts at self-change. The generally negative outcome of many such self-change efforts makes it difficult to understand why so many individuals persist at these attempts. The authors have described this cycle of failure and renewed effort as a "false hope syndrome" characterized by unrealistic expectations about the likely speed, amount, ease, and consequences of self-change attempts. In this article, the authors further develop their conceptualization of this syndrome and review its evidential basis. They review the reasons why so many people tend to fail in their self-change attempts and then examine how people interpret these failures in such a way that they are led to keep trying repeatedly despite apparently overwhelming odds. Finally, the authors discuss the psychological consequences of repeated failure and analyze the distinction between confidence and overconfidence.     

Conflict resolution and peer mediation in middle schools: extending the process and outcome knowledge base

Many professional educators are implementing school-based prevention focused on conflict resolution (CR) and peer mediation (PM). The authors conducted research on CR-PM in 3 middle schools. Specifically, they surveyed teachers and students, tracked disciplinary incidents across school years, collected mediation data, and compared mediators with a matched sample to determine attitudinal change as a result of PM training and experience. The authors also surveyed peer mediators and disputants about program satisfaction, as well as peer mediators and their parents about the generalization of PM skills. The authors conclude with implications for developing future CR programs, including a focus on mediation-process evaluation as well as schoolwide outcome measures and the use of peer mediation training as an intervention for students at risk.     

The role of collaborative planning in children's source-monitoring errors and learning.

The aim of this research was to provide empirical evidence for a cognitive process that may contribute to children's learning from another person. A cornerstone of Vygotsky's sociocultural theory is that knowledge is internalized from others; however, the cognitive processes that support this transformation are underspecified. In a series of three studies, kindergarten children (mean age 5 years 8 months) participated in a categorization task with an adult in several collaborative and noncollaborative conditions and then were tested on their memory of who had performed which actions in the task. After the memory task, children were asked to recategorize the items on their own. Source-monitoring patterns and children's learning varied across conditions according to predictions. A measure of recoding was related to children's planning language that, in turn, predicted learning among the children. The results suggest that one process that contributes to children's internalization of knowledge may involve recoding of agent information and that recoding can be indexed by source-monitoring performance.     

Reducing child witnesses' false reports of misinformation from parents.

This study explored whether a source-monitoring training (SMT) procedure, in which children distinguished between events they recently witnessed versus events they only heard described, would help 3- to 8-year-olds to report only experienced events during a target interview. Children (N = 132) who witnessed science demonstrations and subsequently heard their parents describe nonexperienced events received SMT before or after a forensic-style interview. SMT reduced the number of false reports that 7- and 8-year-old children reported in response to direct questions but had no impact on the performance of younger children. Combined with earlier results, these data suggest a transition between 3 and 8 years of age in the strategic use of source-monitoring information to support verbal reports, such that only 7- and 8-year-olds generalize training to a difficult memory task that does not include mention of specific alternative sources.     

Can the Edinburgh Risk of Repetition Scale Predict Repetition of Deliberate Self‐poisoning in an Australian Clinical Setting?

This study tested the ability of the Edinburgh Risk of Repetition Scale (ERRS) to identify patients at high risk for repeat deliberate self-poisoning (DSP). Consecutive DSP patients (N= 1,317) over a 3-year period were followed-up for 12 months. A statistically significant relationship between ERRS scores and repetition was observed; however, sensitivity and specificity were low. Logistic regression analysis revealed only "previous parasuicide" contributed significantly to repetition. The ERRS had limited value in identifying patients at high risk of repeat DSP in this clinical population.     

Care, communication and conversation

The professionalisation of care has resulted in ever increasing specialisation, use of technical innovations and informatisation. This has had consequences for the level and way of involvement of the care provider vis-a-vis the patient. The result has been growing alienation on the part of the patient and flight into non-classical medicine, as well as frustration on the part of medical personnel, likewise with respect to the reactions of patients. A solution is usually sought in more communication. This might be styled the professional answer to alienation and frustration, whereby 'the human factor', it is hoped, can be better accounted for. Enhanced communication implies two elements: 1) to better cater for the feelings of patients by trained communicators, i.e. more openness, more client satisfaction; 2) to better take into account patient rights and to actually implement them. The question is whether measures in terms of communication, geared at enhancing client satisfaction and the implementation of patient rights, are the real answer to the above mentioned alienation and frustration. Perhaps the trouble has deeper reasons and requires taking other dimensions into account such as decency and human dignity, which cannot be captured simply in terms of satisfaction and rights. This would mean that the answer must be sought at a deeper level than communication. This level might be called 'conversation' (using a concept analysed by Michael Oakeshott). In the second part of the paper, the possible relationship between care and conversation will be briefly analysed.     

The Web and the Quilt: Alternatives to the Heroic Journey Toward Spiritual Development

This paper poses a feminist challenge to stage models of spiritual development and suggests alternative metaphors to the common image of a heroic journey. Women's spirituality is typically more intuitive and relational than rational and individualistic and to express this, we employ metaphors of the web and the quilt. Support for the relevance of these metaphors comes from the spiritual autobiography of Jane Goodall, an anthology of African American women's writings about spirituality, and two qualitative research investigations of older women's spirituality. We conclude with an autobiographical account of our own spiritual development and engage in a dialogue-on-the-page in which we respond to each other's narratives.