Frequent false hearing by older adults: the role of age differences in metacognition

In two experiments testing age differences in the subjective experience of listening, which we call meta-audition, young and older adults were first trained to learn pairs of semantic associates. Following training, both groups were tested on identification of words presented in noise, with the critical manipulation being whether the target item was congruent, incongruent, or neutral with respect to prior training. Results of both experiments revealed that older adults compared to young adults were more prone to "false hearing," defined as mistaken high confidence in the accuracy of perception when a spoken word had been misperceived. These results were obtained even when performance was equated across age groups on control items by reducing the noise level for older adults. Such false hearing is shown to reflect older adults' heavier reliance on context. Findings suggest that older adults' greater ability to benefit from semantic context reflects their bias to respond consistently with the context, rather than their greater skill in using context. Procedures employed are unique in measuring the subjective experience of hearing as well as its accuracy. Both theoretical and applied implications of the findings are discussed. Convergence of results with those showing higher false memory, and false seeing are interpreted as showing that older adults are less able to constrain their processing in ways that are optimal for performance of a current task. That lessened constraint may be associated with decline in frontal-lobe functioning.     

The detection of feigned disabilities: the effectiveness of the Personality Assessment Inventory in a traumatized inpatient sample

Research on feigned mental disorders indicates that severe psychopathology coupled with significant trauma histories often complicate feigning determinations, resulting in inaccuracies on otherwise effective measures. As part of malingering assessments, the Personality Assessment Inventory (PAI) is often used because of its excellent validation and the availability of three feigning indicators (Negative Impression, Malingering Index, and Rogers Discriminant Function), which have evidenced large effect sizes and clinically useful cut scores. The current study examined the effectiveness of the PAI in a traumatized inpatient sample using a between-subjects simulation design. Although Negative Impression appeared affected by trauma--especially in conjunction with dissociative symptoms--very positive results were found for Malingering Index and Rogers Discriminant Function. They remained relatively unelevated under honest conditions, despite posttraumatic stress disorder and extensive comorbidity. Using single-point cut scores provided moderately good classification of feigned and genuine PAI profiles. For purposes of classification, the authors operationally defined small indeterminate groups that were considered too close to classify (i.e., ±5T of the cut scores). With indeterminate cases removed, the overall classification rates improved modestly. However, the more important finding involved the error rates for the indeterminate group, which exceeded 50%. Directions for further research are discussed.     

Understanding all inconsistency compensation as a palliative response to violated expectations

It has been repeatedly shown that, when people have experiences that are inconsistent with their expectations, they engage in a variety of compensatory efforts. Although there have been many superficially different accounts for these behaviors, a potentially unifying inconsistency compensation perspective is currently coalescing. Following from a common prediction error/conflict monitoring mechanism, any given inconsistency is understood as evoking a common syndrome of aversive arousal. In turn, this aversive arousal is understood to motivate palliative efforts, which manifest as the analogous compensation behaviors reported within different psychological literatures. Based on this perspective, compensation efforts following both 'high-level' (e.g., attitudinal dissonance) and 'low-level' (e.g., Stroop task color/word mismatches) inconsistencies can now be understood in terms of a common motivational account.     

Spiritual Integration Predicts Self-Reported Mental and Physical Health

Data from 167 participants were used to establish the psychometric properties of the Reidhead spiritual integration scale, 31-item version (SI-31). Structural equation modeling was used to empirically evaluate influences on perceived health functioning, while accounting for possible confounds. The analyses showed that SI-31 predicted perceived mental and physical health while controlling for life satisfaction, religious variables, mood patterns, depression symptoms, and demographics. The importance of SI as a predictor of health-related outcomes is supported, as is the usefulness of the SI-31 in predicting these outcomes.     

Person and environmental factors associated with well-being in medical students

Medical students are exposed to demanding academic workloads and are often under considerable psychological strain. This study examined important person and environmental variables that might predict their psychological well-being. Participants were 755 students in years 2-6 from 11 Australian medical schools. A web-based survey assessed well-being, personality, professional expectations, lifestyle expectations, barriers, academic stress, and debt. A hierarchical regression analysis demonstrated that extraversion, conscientiousness, professional expectations, and lifestyle expectations were positively associated with well-being, while academic stress, which was the strongest predictor, neuroticism, and concern about debt were negatively associated. Medical students who displayed a disposition that was outgoing, conscientious, and stable, who were less stressed about their academic workload and their level of debt, and who held higher expectations for their future professional career, and expectations of a balanced lifestyle, had better well-being. Medical educators should be aware of these factors and provide support and strategies that promote well-being to students during medical training.     

A generalized least squares regression approach for computing effect sizes in single-case research: application examples

A new method for deriving effect sizes from single-case designs is proposed. The strategy is applicable to small-sample time-series data with autoregressive errors. The method uses Generalized Least Squares (GLS) to model the autocorrelation of the data and estimate regression parameters to produce an effect size that represents the magnitude of treatment effect from baseline to treatment phases in standard deviation units. In this paper, the method is applied to two published examples using common single case designs (i.e., withdrawal and multiple-baseline). The results from these studies are described, and the method is compared to ten desirable criteria for single-case effect sizes. Based on the results of this application, we conclude with observations about the use of GLS as a support to visual analysis, provide recommendations for future research, and describe implications for practice.     

Bergmann’s dilemma: exit strategies for internalists

Michael Bergmann claims that all versions of epistemic internalism face an irresolvable dilemma. We show that there are many plausible versions of internalism that falsify this claim. First, we demonstrate that there are versions of “weak awareness internalism” that, contra Bergmann, do not succumb to the “Subject’s Perspective Objection” horn of the dilemma. Second, we show that there are versions of “strong awareness internalism” that do not fall prey to the dilemma’s “vicious regress” horn. We note along the way that these versions of internalism do not, in avoiding one horn of the dilemma, succumb to the dilemma’s other horn. The upshot is that internalists have many available strategies for avoiding dilemmatic defeat.     

Measuring Productivity in Primary Care Behavioral Health: A Delphi Study

High productivity by behavioral health consultants (BHC) is a defining aspect of the primary care behavioral health (PCBH) model to maximize access to care and is often measured by patient volume. Studies of productivity in health care settings suggest a single productivity target may not be optimal. We used a Delphi method to obtain expert consensus on an operational definition of high productivity by BHCs in the PCBH model. Clinicians, managers, and researchers in PCBH were recruited to participate in a multi-round survey using a modified Delphi technique and develop consensus on PCBH productivity metrics. Ten participants completed all three survey rounds and rated 28 metrics. After three rounds, two direct metrics (average number of billable BHC visits each day; number of patients seen per day) received at least 80% consensus as “Essential”, two received at least 50%, and five received less than 50%. One influencer (level of integration at the practice) received at least 80% consensus as “Very Much” influential, 19 received at least 50%, and eight items received less than 50%. Several themes arose from participant comments. PCBH productivity can be interpreted as being high volume. Numerous practice factors influence how productive a BHC may be. Future studies should determine the feasibility of our metrics in clinical practice, establish productivity expectations based on patient needs and clinic resources, and identify patient-, clinician-, or practice-level moderators of productivity.