Exploring Temporal Progression of Events Using Eye Tracking

This study investigates the representation of the temporal progression of events by means of the causal change in a patient. Subjects were asked to verify the relationship between adjectives denoting a source and resulting feature of a patient. The features were presented either chronologically or inversely to a primed event context given by a verb (to cut: long–short vs. short–long). Effects on response time and on eye movement data show that the relationship between features presented chronologically is verified more easily than that between features presented inversely. Post hoc, however, we found that the effects of temporal order occurred only when subjects read the features more than once. Then, the relationship between the features is matched with the causal change implied by the event context (contextual strategy). When subjects read the features only once, subjects respond to the relationship between the features without taking into account the event context.     

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (M_age = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (β_s range from ?.31 to ?.18, p_s < .01).

Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.     

National attitudes towards mental health treatment: the importance of research evidence

Most conceptualizations of evidence-based practice view it as a “three legged stool” consisting of: the use of best available research evidence, clinical expertise, and client preferences. Although empirical evidence and clinical expertise have received greater empirical attention, relatively little research has systematically explored client preferences. The present study analyzed self-reported treatment preferences for various clinical and non-clinical presentations. Adult participants (n = 1262) residing in the United States were presented with diagnostic vignettes and rated their relative preferences among 5 treatment variables, including: use of an empirically supported treatment (EST), quality of the client–therapist relationship, therapist empathy, therapist experience, and client speaking for the majority of therapy sessions. Results indicated that participants endorsed significant preference for receiving an EST over other treatment variables for all clinical disorders, with effect sizes ranging from small to large depending on the diagnosis. There was slightly greater variability in treatment preferences for non-clinical issues, though participants generally reported greater preference for receiving an EST. Follow-up questions provided further evidence for EST preferences. The implications of these results are discussed.     

A laboratory model for evaluating relapse of undesirable caregiver behavior

The success of behavioral treatments like functional communication training depends on their continued implementation outside of the clinical context, where failures in caregiver treatment adherence can lead to the relapse of destructive behavior. In the present study, we developed a laboratory model for evaluating the relapse of undesirable caregiver behavior that simulates two common sources of disruption (i.e., changes in context and in treatment efficacy) believed to affect caregiver treatment adherence using simulated confederate destructive behavior. In Phase 1, the caregiver's delivery of reinforcers for destructive behavior terminated confederate destructive behavior in a home‐like context. In Phase 2, the caregiver implemented functional communication training in a clinical context in which providing reinforcers for destructive or alternative behavior terminated confederate destructive behavior. In Phase 3, the caregiver returned to the home‐like context, and caregiver behavior produced no effect on confederate destructive or alternative behavior, simulating an inconsolable child. Undesirable caregiver behavior relapsed in three of four treatment‐adherence challenges.     

Economic Impact of the Statewide Implementation of an Evidence-Based Treatment: Multisystemic Therapy in New Mexico

Several states have made considerable investments into large-scale implementation of evidence-based treatments (EBTs), yet little is known about key success indicators for these implementation efforts such as cost and sustainability. To that end, the present study examined the economic impact of statewide implementation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cuningham, 2009), a family- and community-based behavioral EBT for serious juvenile offenders in New Mexico. Participants were 1,869 youth who received MST across 23 teams during the study period. We conducted a cost-benefit analysis using metrics from state data sources that compared the cost of MST to its benefits (i.e., avoided expenses from pre- to posttreatment) in two domains: (a) behavioral health services (i.e., Medicaid claims) and (b) juvenile crime (i.e., taxpayer expenses, tangible and intangible expenses to crime victims). MST costs were based on Medicaid claims, which were reimbursed at an enhanced billing rate that was intended to cover expenses for both clinical and implementation (e.g., training, quality assurance) activities. Results suggest that implementation of MST in New Mexico over the 7-year study period may have produced net benefits, through 2 years posttreatment, of more than $4,643 per youth in avoided behavioral health claims and $15,019 per youth through reductions in juvenile crime. Stated differently, every dollar that New Mexico spent on MST appeared to have returned $3.34 for a total benefit of $64.2 million over the course of the study. We discuss implications of these findings for policymakers, administrators, and researchers who are interested in increasing the sustainability of complex EBTs in community settings.     

Predictors and Outcomes of Sudden Gains and Sudden Regressions in Cognitive Behavioral Therapy for Youth Anxiety

Sudden gains (SGs), referring to large, stable symptom improvement occurring between consecutive treatment sessions, have been associated with improved outcomes among adults with various psychological disorders. Little research exists on SGs or sudden symptom worsening (i.e., sudden regressions [SRs]) during treatment for youth disorders. The current study examined predictors and outcomes of SGs/SRs via multiple informants in youth anxiety treatment. Participants were 118 youth (age M = 11.6, SD = 2.5; 53.8% female) and their caregivers receiving a cognitive-behavioral therapy protocol for a principal anxiety disorder. Anxiety symptom severity was assessed weekly via the State-Trait Anxiety Inventory for Children–Trait–Child/Parent versions. SGs and SRs occurred in 45.8 and 31.3% of youth, respectively. SRs were more common among youth with comorbid mood or externalizing disorders, while SGs occurred more often among youth with greater pretreatment anxiety symptom severity. SGs were not associated with posttreatment outcomes, but SRs predicted significantly higher posttreatment internalizing symptoms based on child report (β = .23, p = .03) and externalizing symptoms based on child (β = .15, p = .04) and parent report (β = .16, p = .03), controlling for overall magnitude of symptom change. SRs among youth receiving cognitive-behavioral therapy for anxiety are associated with pretreatment clinical complexity and poorer posttreatment outcomes and may serve as a warning sign to clinicians of possible treatment failure.     

Assessing the combined effects of resurgence and reinstatement in children diagnosed with autism spectrum disorder

Resurgence and reinstatement are laboratory models of relapse following treatments for problem behavior that arrange alternative sources of reinforcement, such as differential reinforcement of alternative behavior and noncontingent reinforcement. Resurgence models the elimination or reduction of reinforcers during treatment and reinstatement models the re‐presentation of reinforcers previously maintaining problem behavior. The present study examined individual and combined effects of resurgence and reinstatement in a translational model of treatment relapse with three children diagnosed with Autism Spectrum Disorder. We first reinforced and then extinguished an arbitrary response while providing access to a preferred toy to model a version of noncontingent reinforcement with extinction. In the following phases, we examined resurgence by removing the toy, reinstatement by presenting the training reinforcer response‐independently, and a combination of resurgence and reinstatement. Overall, relapse of target responding reliably exceeded functionally similar responses never reinforced in the experimental situation. Most importantly, relapse tended to be greater when combining resurgence and reinstatement than when assessing either alone. These findings support previous studies showing that combinations of operations can increase treatment relapse. This translational model arranging simulated problem behavior with arbitrary tasks provides a platform from which to thoroughly and systematically assess methods for understanding and improving behavioral treatments.     

Power Evangelism in a Protestant Context? Reflections after a Workshop in Samosir/Indonesia

This article discusses how the neo‐Pentecostal concept of power evangelism, read from a liberation perspective, might be useful to contextualize evangelism in the Toba Batak region of Samosir. In a situation where evangelistic preaching follows an evangelical forensic paradigm but Christians turn to traditional religious rituals for blessing, healing, and protection, a new approach is needed. Preaching and liturgies informed by a power paradigm might resolve the problem of syncretism, but important theological questions need to be clarified.