Recruiting Young Adult Cancer Survivors for Behavioral Research

Young adults have been dramatically underrepresented in cancer survivorship research. One contributing factor is the difficulty recruiting this population. To identify effective recruitment strategies, the current study assessed the yield of strategies used to recruit young survivors for an exercise intervention including: clinic-based recruitment, recruitment at cancer-related events, mailings, telephone-based recruitment, advertising on the internet, radio, television and social networking media, distributing brochures and word-of-mouth referrals. When taking into account the strategies for which we could track the number of survivors approached, recruitment at an oncology clinic was the most productive: 38 % of those approached were screened and 8 % enrolled. When evaluating which strategy yielded the greatest percentage of the sample, however, mailings were the most productive. Given widespread use of the internet and social networking by young adults, investigators should also consider these low-cost recruitment strategies.     

Lessons learned: the effect of prior technology use on Web-based interventions.

This study examined the role of regular prior technology use in treatment response to an online family problem-solving (OFPS) intervention and an Internet resource intervention (IRI) for pediatric traumatic brain injury (TBI). Participants were 150 individuals in 40 families of children with TBI randomly assigned to OFPS intervention or an IRI. All families received free computers and Internet access to TBI resources. OFPS families received Web-based sessions and therapist-guided synchronous videoconferences focusing on problem solving, communication skills, and behavior management. All participants completed measures of depression, anxiety, and computer usage. OFPS participants rated treatment satisfaction, therapeutic alliance, and Web site and technology comfort. With the OFPS intervention, depression and anxiety improved significantly more among technology using parents (n = 14) than nontechnology users (n = 6). Technology users reported increasing comfort with technology over time, and this change was predictive of depression at followup. Satisfaction and ease-of-use ratings did not differ by technology usage. Lack of regular prior home computer usage and nonadherence were predictive of anxiety at followup. The IRI was not globally effective. However, controlling for prior depression, age, and technology at work, there was a significant effect of technology at home for depression. Families with technology experience at home (n = 11) reported significantly greater improvements in depression than families without prior technology experience at home (n = 8). Although Web-based OFPS was effective in improving caregiver functioning, individuals with limited computer experience may benefit less from an online intervention due to increased nonadherence.     

Implicit and explicit memory for affective passages in temporal lobectomy patients

Eighteen temporal lobectomy patients (9 left, LTL; 9 right, RTL) were administered four verbal tasks, an Affective Implicit Task, a Neutral Implicit Task, an Affective Explicit Task, and a Neutral Explicit Task. For the Affective and Neutral Implicit Tasks, participants were timed while reading aloud passages with affective or neutral content, respectively, as quickly as possible, but not so quickly that they did not understand. A target verbal passage was repeated three times; this target passage was alternated with other previously unread passages, and all passages had the same number of words. The Explicit Affective and Neutral Tasks were administered at the end of testing, and consisted of multiple choice questions regarding passage content. Verbal priming effects in terms of improved reading speed with repetition for the target but not non-target passages were found for patients with both left and right temporal lobectomies. As in the Burton, Rabin et al. [Burton, L., Rabin, L., Vardy, S.B., Frohlich, J., Wyatt, G., Dimitri, D., Constante, S., Guterman, E. (2004). Gender differences in implicit and explicit memory for affective passages. Brain and Cognition, 54(3), 218-224] normative study, there were no interactions between this priming effect and affective/neutral content. For the explicit tasks, items from the repeated passages were remembered better than the unrepeated passages, and there was a trend for information from the affective passages to be remembered better than the neutral passages, similar to the normative pattern. The RTL group did not show the normative pattern of slower reading speed for affective compared to neutral passages that the LTL group showed. Thus, the present findings support the idea that intact right medial temporal structures are important for affective content to influence some aspects of verbal processing.     

The Red Herring technique: a methodological response to the problem of demand characteristics

In past research, we planted false memories for food related childhood events using a simple false feedback procedure. Some critics have worried that our findings may be due to demand characteristics. In the present studies, we developed a novel procedure designed to reduce the influence of demand characteristics by providing an alternate magnet for subjects' natural suspicions. We used two separate levels of deception. In addition to giving subjects a typical untrue rationale for the study (i.e., normal deceptive cover story), we built in strong indicators (the "Red Herring") that the study actually had another purpose. Later, we told subjects that we had deceived them, and asked what they believed the "real purpose" of the study was. We also interviewed a subset of subjects in depth in order to analyze their subjective experiences of the procedure and any relevant demand. Our Red Herring successfully tricked subjects, and left little worry that our false memory results were due to demand. This "double cross" technique may have widespread uses in psychological research that hopes to conceal its real hypotheses from experimental subjects.     

Turning differences into possibilities: Using discourse analysis to investigate change in therapy with adolescents and their families

Discourse analysis affords researchers and practitioners improved understandings regarding how positive outcomes are accomplished in the conversations of family therapy. By investigating how change is constructed or ‘performed’ in therapeutic interactions, its analyses conceptually parallel those of the social constructionist approaches to family therapy. In this respect, discourse analysis offers empirical methods to examine claims about the constructive aspects of therapeutic conversations. These conceptual and research parallels are examined in how impasses in family therapy were transcended, rhetorically, between an adolescent, his parents and the therapist. We conclude that the research methods of discourse analysis can directly enhance the conversational skills and methods of therapists.     

Evaluating Treatments for Functionally Equivalent Problem Behavior Maintained by Adult Compliance with Mands During Interactive Play

A primary goal of behavioral interventions is to reduce dangerous or inappropriate behavior and to generalize treatment effects across various settings. However, there is a lack of research evaluating generalization of treatment effects while individuals with functionally equivalent problem behavior interact with each other. For the current study, the severe problem behavior of two participants with developmental disabilities was targeted for assessment and treatment. Results of a functional analysis indicated that for both participants, problem behaviors occurred when destructive behavior produced reinforcement of participant mands . The use of a multiple schedule that alternated between differential reinforcement of other behaviors and differential reinforcement of alternative behavior (mands) was sufficient to produce a significant reduction in problem behavior for one participant; the addition of differential reinforcement of alternative behaviors via compliance was necessary for the second participant. Extended treatment sessions, which focused on interaction between the two participants, involved one therapist concurrently implementing each participant’s treatment while they were directed to play with one another (a situation that previously evoked problem behavior). Results show that each participant’s treatment produced low to zero rates of problem behavior even during extended interactions.     

Conceptual mastery and the knowledge argument

According to Frank Jackson’s famous knowledge argument, Mary, a brilliant neuroscientist raised in a black and white room and bestowed with complete physical knowledge, cannot know certain truths about phenomenal experience. This claim about knowledge, in turn, implies that physicalism is false. I argue that the knowledge argument founders on a dilemma. Either (i) Mary cannot know the relevant experiential truths because of trivial obstacles that have no bearing on the truth of physicalism or (ii) once the obstacles have been removed, Mary can know the relevant truths. If we give Mary the epistemological capabilities necessary to draw metaphysical conclusions about physicalism, she will, while trapped in the black and white room, be able to know every truth about phenomenal experience.     

Dissemination and Implementation of Cognitive Behavioral Therapy for Depression in the Kaiser Permanente Health Care System: Evaluation of Initial Training and Clinical Outcomes

Notwithstanding its empirical status and strong recommendation in clinical practice guidelines, cognitive behavioral therapy (CBT) continues to be delivered infrequently and with low fidelity on the clinical front lines. Recently, organized efforts and policies within the public sector to disseminate and implement CBT and other evidence-based psychotherapies have yielded encouraging results and provided optimism for bridging the research-to-practice-gap. Following from these efforts, the current article examines the initial impact and experience of the implementation of an individualized approach to CBT training and treatment within the Kaiser Permanente health care system. Initial training outcomes, including changes in general and specific competencies, were assessed using divergent assessment methods within the initial cohort of therapists undergoing training. Initial patient outcomes, including changes in depression and anxiety, were assessed among patients receiving treatment from therapists in training. Results revealed training in and implementation of CBT-D was associated with overall large improvements in therapist competencies and in clinically significant improvements in both depression and anxiety among patients. Findings from the initial phase of dissemination and implementation within a large private system provide support for, and extend recent findings related to, the feasibility and effectiveness of training in and implementation of CBT-D in a real-world context.