Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients

Cancer-related fatigue (CRF) is a significant clinical problem for more than 10 million adults diagnosed with cancer each year worldwide. No "gold standard" treatment presently exists for CRF. To provide a guide for future research to improve the treatment of CRF, the authors conducted the most comprehensive combined systematic and meta-analytic review of the literature to date on non-pharmacological (psychosocial and exercise) interventions to ameliorate CRF and associated symptoms (vigor/vitality) in adults with cancer, based on 119 randomized controlled trials (RCTs) and non-RCT studies. Meta-analyses conducted on 57 RCTs indicated that exercise and psychological interventions provided reductions in CRF, with no significant differences between these 2 major types of interventions considered as a whole. Specifically, multimodal exercise and walking programs, restorative approaches, supportive-expressive, and cognitive-behavioral psychosocial interventions show promising potential for ameliorating CRF. The results also suggest that vigor and vitality are distinct phenomena from CRF with regard to responsiveness to intervention. With improved methodological approaches, further research in this area may soon provide clinicians with effective strategies for reducing CRF and enhancing the lives of millions of cancer patients and survivors.     

Upsetting Behavior: Reactions to Personal and Bystander Sexual Harassment Experiences

The current research was designed to examine objective and contextual factors related to the appraisal of potentially sexually harassing situations. Working female participants (n = 208) from a mid-sized southwestern university completed a workplace experiences survey in small groups. The majority of participants were Hispanic/Latina (77.9%). We predicted that characteristics of personal harassment experiences (e.g., number of distinct types of behaviors experienced, frequency, duration) and bystander harassment experiences would contribute independently to how upset women were by their own sexual harassment experiences. Results indicated that characteristics of personal harassment experiences and bystander experiences did predict how upset women were by their own gender harassment and by unwanted sexual attention experiences. Results are discussed in terms of the importance of considering multiple types of workplace stressors (e.g., personal and bystander sexual harassment experiences) and their relation to the appraisal process.     

Parsing the relations between SES and stress reactivity: examining individual differences in neonatal stress response

In an effort to further delineate the reported relations between socioeconomic status (SES) and stress reactivity in children, associations between three domains of perinatal risk: socio-demographic, obstetrical complications, and maternal psychological factors during the perinatal period, and cortisol and behavioral reactivity were examined in 100 healthy African American neonates whose families resided in low-income environments. Behavioral and cortisol response to a heel stick and the Neonatal Behavioral Assessment Scale (NBAS) was measured within the first 2 days of life. Significant associations were found between socio-demographic risk, obstetrical complications, and maternal psychological factors and neonatal behavior and cortisol in the context of the NBAS; few significant associations were found in the context of the heel stick. Greater magnitude of perinatal risk was associated with both higher and lower than average neonatal stress reactivity. The results provide preliminary data on the types of perinatal experiences that may have significant effects on stress reactivity in humans, especially in the context of families living in poverty. Application of these data to the hypothesis that prenatal stress results in programming of the fetal/neonatal stress response system is discussed.     

Separating cue encoding from target processing in the explicit task-cuing procedure: are there "true" task switch effects?

Six experiments were conducted to separate cue encoding from target processing in explicitly cued task switching to determine whether task switch effects could be separated from cue encoding effects and to determine the nature of the representations produced by cue encoding. Subjects were required to respond to the cue, indicating which cue was presented (Experiments 1, 3a, and 4a) or which task was cued (Experiments 2, 3b, and 4b), before performing the cued task on the target. Cue encoding was successfully separated from target processing when the cue response indicated which task was cued but not when it indicated which cue was presented. Task switch effects were found when this separation was successful, suggesting that there are "true" task switch effects independent of cue encoding. Analysis of the conditions required for successful separation suggested that cue encoding results in a semantic categorical representation of the task to be performed rather than verbal or phonological representations of individual cues. Implications for the authors' past modeling of task-switching performance are discussed.     

Exploring the mental number line: evidence from a dual-task paradigm

In a parity-judgment task smaller numbers are responded to faster with the left-hand key and vice versa for larger numbers (SNARC effect; Dehaene et al., in Journal of Experimental Psychology: General, 122, 371-396, 1993). We used the psychological refractory period paradigm involving a parity-judgment task and tone-discrimination task to address the question at which stage this effect arises. When the parity-judgment task is performed second, then we found equal SNARC effects for the short and the long SOA. According to the central bottleneck model, this indicates that the effect arises during the response-selection or execution stage. In Experiment 2 the parity-judgment task was performed first. The pattern of results indicates that the SNARC effect originates during the perceptual encoding or response-selection. Together, our results suggest that the SNARC effect originates while the response is selected.     

Evidenzbasierte Psychotherapie

Zusammenfassung Seit einiger Zeit wird auch in der Psychotherapie – so wie in anderen Bereichen der Medizin – eine intensive und kontroverse Diskussion über die wissenschaftlichen Standards und deren Praxisrelevanz geführt. Dabei nehmen Fragen der Qualitätssicherung und der Entwicklung von Leitlinien einen zunehmenden Raum ein. Von besonderer Bedeutung sind in diesem Zusammenhang die Evidence Based Medicine (EbM) und ihre methodischen Standards, in deren Mittelpunkt experimentelle Therapiestudien stehen. Im Beitrag wird das Konzept der Evidence Based Medicine im Kontext der Psychotherapie (Evidence based Psychotherapy) vorgestellt und unter methodischen und inhaltlichen Gesichtspunkten diskutiert. Eine zentrale Frage ist dabei die inhaltliche Aussagekraft und die Übertragbarkeit von wissenschaftlichen Befunden auf die klinische Praxis.      

Cumulative risk, maternal responsiveness, and allostatic load among young adolescents

The purpose of this study was to examine the impact of cumulative risk exposure in concert with maternal responsiveness on physiological indicators of chronic stress in children and youth. Middle-school children exposed to greater accumulated psychosocial (e.g., family turmoil, poverty) and physical (e.g., crowding, substandard housing) risk factors manifested higher levels of allostatic load, a physiological marker of cumulative wear and tear on the body caused by the mobilization of multiple, physiological response systems. This effect was longitudinal, residualizing allostatic load 3-4 years earlier when the youth were in elementary school. This effect, however, occurred only among adolescents with mothers low in responsiveness. Cumulative risk was also associated with dynamic cardiovascular processes in response to an acute stressor (mental arithmetic). Higher risk was associated with muted reactivity and slower, less efficient recovery in blood pressure. These dynamic cardiovascular effects occurred irrespective of maternal responsiveness.     

Exploring Power and Gender Issues Emergent in an Institutional Workshop on Preventing Clergy Sexual Misconduct

The Eastern Synod of the Evangelical Lutheran Church in Canada (ELCIC) sponsors the Crossing the Boundaries (CTB) workshop, a program that focuses on the maintenance of appropriate boundaries in clergy-congregant relationships as a means to prevent clergy sexual misconduct. Drawing primarily on an analysis of the synod-sanctioned workshop materials, an observation of the workshop, and interviews with 10 pastors who have attended the workshop, this paper explores differing conceptions of power and gender held by the synod officials and workshop participants.