Conducting Outcomes Research in a Clinical Practice Setting: The Effectiveness and Acceptability of Acceptance and Commitment Therapy (ACT) in a Partial Hospital Program

Multiple challenges exist integrating research into clinical practice, particularly in acute care settings where randomized controlled trials may be impractical or unethical. Partial or day hospitals are one such setting. As compared to outpatients and inpatients, relatively little research is conducted or reported in partial hospital program (PHP) patients, leaving providers in this setting without a solid empirical basis from which to draw. We report treatment outcomes and patient satisfaction from the first 750 patients enrolled in a clinical research PHP utilizing the acceptance and commitment therapy (ACT) treatment model. ACT is a well-established, transdiagnostic behavior therapy. However, to date no study has examined the use of ACT in acute day hospitals. We hypothesized that applying ACT with this patient group would result in significantly improved depression, anxiety, functioning, and quality of life from intake to discharge. We additionally expected that patients would report high satisfaction with ACT treatment groups. Patients (n = 750 full sample, n = 518 completed treatment) completed daily measures of symptoms, functioning, and ACT processes at intake and discharge, and postgroup satisfaction surveys. Results showed significant improvements in symptoms and impairment. ACT process variables also increased over the course of treatment. Importantly, patient satisfaction was high for all groups. Thus, ACT provides an appropriate, flexible, effective, and satisfactory model for this patient group. A comparison of our findings using ACT to the limited research using other models in PHP settings is discussed, as well as challenges in the overall process of integrating research into routine clinical care.     

MMPI Item Changes by College Students under Ideal-Self Response Set

This paper reports item changes when college students were asked to assume a set to the MMPI in which they answer as they “would like to be.” Accumulated evidence from several populations separated by a period of years and by culture background demonstrated a consensual profile. While weighted in the direction of social favorability, the group profile is distinguished by a theme of self-mastery in social situations. Item analysis indicated an area of idealized acceptance or rejection of items which has potential value in personality assessment. The findings also have implications for desirability as a factor in MMPI records and for the validity of “subtle” items.     

Statistical Significance Levels of Nonparametric Tests Biased by Heterogeneous Variances of Treatment Groups

The statistical significance levels of the Wilcoxon-Mann-Whitney test and the Kruskal-Wallis test are substantially biased by heterogeneous variances of treatment groups—even when sample sizes are equal. Under these conditions, the Type I error probabilities of the nonparametric tests, performed at the .01, .05, and .10 significance levels, increase by as much as 40%-50% in many cases and sometimes as much as 300%. The bias increases systematically as the ratio of standard deviations of treatment groups increases and remains fairly constant for various sample sizes. There is no indication that Type I error probabilities approach the significance level asymptotically as sample size increases.     

Use of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0–3R) with Canadian Infants and Young Children Prenatally Exposed to Substances

The current study examined the mental health diagnostic profiles of infants and young children prenatally exposed to substances using the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0–3R) diagnostic system. Participants were 46 biological mother–infant dyads who were engaged in a clinical program for mothers with substance‐use problems and their young children (aged 10–41 months). Diagnostic information was reported for each of the five axes listed in the DC:0–3R diagnostic system based on file reviews. In addition, the children's socioemotional and adaptive behaviors were assessed using the Child Behavior Checklist, Infant–Toddler Social Emotional Assessment, the Social‐Emotional Scale, and the Adaptive Behavior Assessment System (2nd ed.). In this sample of young children with prenatal substance exposure, a broad range of socioemotional symptoms were evident, with almost one third of the children meeting criteria for at least one Axis I mental health diagnosis. In addition, the majority of dyads demonstrated features of a disordered relationship. Children in more problematic relationships demonstrated higher levels of socioemotional and adaptive functioning difficulties and were more likely to have an Axis I diagnosis than were children in adapted relationships. The importance of early intervention efforts aimed at infants with prenatal substance exposure and their biological mothers is highlighted, with a particular focus on enhancing the quality of the mother–child relationship.     

Measuring Up: Assessing the Measurement Properties of Two Self-Control Scales

Only recently has research explored patterns in the nature of violence within and across communities. Recent reports highlight the importance of both the individual characteristics and contextual environments of violent offenders, especially youth offenders. The current study examines the effects of both individual- and contextual-level characteristics on the nature of violence committed by youths as compared to adults. Specifically, we merge incident data from the National Incident Based Reporting System with contextual data on the cities in which the incidents occurred. We then use hierarchical linear modeling techniques to explore variations in predictors of offender gun use and victim injury.     

Stigmata and negotiated outcomes: Management of appearance by persons with physical disabilities

This paper explores the role of clothing in the management of appearances by persons with disabilities. A negotiated outcomes perspective is used to study the clothing choices of disabled persons, rather than viewing them as passive recipients of the labels supplied by perceivers. A two‐part study of college students with physical disabilities, including comments from a series of focused group interviews and open‐ended responses to a questionnaire with national distribution, resulted in the data presented. The data indicated that most of the students strived to appear as normative as possible through their clothing choices and accordingly used a variety of techniques: “making do” with ingeniously adapted ready‐to‐wear apparel; using clothes to conceal a disability; deflecting attention from a disability toward more normative but slightly discrediting attributes; compensation through fashionable dress or by emphasizing other social roles and abilities; and social inclusion, i.e., the assertion that all persons vary in physical appearance. Some students employed dress to take advantage of their social uniqueness through such techniques as wearing bright or prominent clothing or by displaying humor. Possible directions for future research on the social interactions of disabled persons, particularly involving the implications of normalizing appearance versus emphasizing social uniqueness, are presented.     

Liking of Movie Genre Alters the Effectiveness of Background Product Placements

Product placement has been likened to evaluative conditioning (EC) in which a viewer's liking of an actor using a brand transfers to the brand. Less research has evaluated how more subtle background placements work. Further, most published studies report explicit brand attitudes as outcome measures. We show that background placements of a familiar brand can alter implicit brand attitudes. Furthermore, viewers who liked the movie genre showed positive implicit attitudes, and viewers who disliked the movie genre showed negative implicit attitudes, suggesting that genre generated affect transferred to implicit attitudes. Advertising implications are discussed.