Reducing the threat value of chronic pain: A preliminary replicated single-case study of interoceptive exposure versus distraction in six individuals with chronic back pain

This paper describes a preliminary experimental evaluation of a technique intended to help people suffering from chronic back pain and low pain acceptance to alter the aversiveness or threat value of their persisting pain. Using a multiple baseline cross-over design six individuals with chronic back pain were taught to use a form of interoceptive exposure as well as a relaxation/distraction breathing-based technique in the presence of their pain. Half the participants used one method for three weeks, and then crossed over to the other method for a further three weeks. The other half did the reverse. Assessments were conducted at pre/post treatment and at a three month follow-up. Daily monitoring of pain-related distress was also completed. The results indicated moderately high improvements in pain acceptance across most participants and corresponding declines in pain-related distress. No clear differences occurred between conditions, but the changes on disability and catastrophising scales for most cases were consistent with those reported after more substantial interventions. The study raises some important clinical and methodological issues that could inform future research in this area.     

事件提示和时间提示对新异干扰的影响—— 来自听视跨通道和听通道的证据

采用Oddball范式考察听视跨感觉通道和听感觉通道中“无关刺激”或“无关属性”的信号提示对新异干扰的影响。实验1和实验2分别比较了听视跨通道和听通道中时间事件提示、时间提示和事件提示三种条件。结果表明：(1)时间提示条件下新异干扰效应消失, 而事件提示条件下新异干扰效应仍存在。无关刺激意外变化引起的靶任务行为受损, 不仅与偏差刺激的小概率和新颖性有关, 而且与干扰刺激与靶子间提示信号关联有关, 这种提示关联中事件发生的提示功能比时间间隔的提示功能更为重要。(2)听通道下新异干扰与视听跨通道结果一致, 无关属性也会起到提示信号作用, 同样事件提示功能比时间提示功能更重要。     

The development of a trait measure of ruminative thought

A 9-item questionnaire was designed to measure rumination. This questionnaire measures three distinct facets of rumination: emotionality, motivation, and distraction. Together, these factors measure the extent to which people engage in thoughts regarding their progress toward their goals. In Study 1, an exploratory factor analysis of an initial 28 items was used to reveal the underlying structure of the rumination construct. In Study 2, a confirmatory factor analysis revealed support for the hypothesized factor structure proposed by Study 1. Following the suggestions of PROC CALIS (SAS) for model modification, an acceptable model was found that retained 9 items (3 on each factor). Studies 3 and 4 demonstrate the predictive validity of the rumination inventory. Study 3 provides evidence of a correlation between distraction by ruminative thoughts and low scores on a statistics examination. Study 4 shows a negative correlation between distraction by ruminative thoughts and time taken to learn to solve a geometric puzzle.     

A probabilistic model of intensive designs

Without internal validity, experimental data are uninterpretable. With intensive designs, most methods presented to quantify a design's internal validity have been subject to criticism. A probabilistic model of intensive designs is presented that demonstrates the high degree of internal validity of these designs without relying on adaptations from traditional inferential statistics. Where the experimenter is able to conform to the restrictions of the model, the equations provide an estimation of internal validity for either reversal or multiple-baseline designs. More importantly, the model provides mathematical bases for some of the common recommendations and design considerations in intensive research (such as the desirability of within-subject replications and of four or more multiple baselines).     

The resource-availability model of distraction and mind-wandering

This article presents a cognitive model of distraction and mind-wandering that combines and formalizes several existing theories. It assumes that task-related goals and opportunities for distraction are continuously in competition for mental resources. If the task-related goal does not need a particular resource at a particular moment, the likelihood that it is captured by a distraction is high. We applied this model to explain the results of three distraction experiments that differ from each other in a number of ways. The first experiment is a slow-paced mind-wandering study; the main result is that less mind-wandering occurs if subjects have to maintain an item in working memory. The second experiment is a working memory task in which mind-wandering is triggered by the presence of self-referential words in a secondary task; these words increase mental elaboration and reduce memory performance. The third experiment is a mental arithmetic/ memory/visual attention task, in which subjects became more distracted by a flanking (irrelevant) video as the task increased in complexity: as subjects need more time to think, they leave the visual resource vulnerable to distraction. Although these phenomena have been treated separately in the literature, we show that these phenomena can be explained by a single comprehensive model that is based on the assumption that distractions target unused cognitive resources.     

The role of psychologists in requests to hasten death: A literature and legislation review and an agenda for future research

The opportunity for patients to request support to die is legalised in several countries and is associated with the development of a social and political debate that has taken place in recent years. We believe that psychologists can contribute to this debate. Here, we conducted a literature and legislation review with the aim of understanding arguments regarding the roles of the psychologist in hastening death. A systematic review of the peer-review literature in this field was carried out. The legislation of each country with hasten death practices was analysed to understand if psychologists are included in the protocols of hasten death practices. Despite a lack of literature, we found competence assessment, communication, psychological counselling, research and training and public policy to be the possible roles of psychologists in requests to hasten death. Based on the review, an agenda for future research is developed. We highlight the importance of psychology, raising its profile in the study of the various forms of death hastening requests.     

What is Psychotherapy for? A Plausible Alternative to Empirically Supported Therapies,Therapy Relationships,and Practice Guidelines

Task forces come up with empirically supported therapies and therapist-client relationships. A careful study of their research provides an empirically supported answer to the long-standing question of what psychotherapy is for. Accordingly, if your way of doing therapy falls outside the empirically based boundary, (a) you can risk declining their practice guidelines; (b) you can develop your own practice guidelines; and (c) you can pursue some exciting implications from having an alternative set of guidelines for how to do psychotherapy. A strategy is proposed as a plausible alternative to the task forces empirically based strategy.     

Genetic Evaluation and Counseling of Couples with Recurrent Miscarriage: Recommendations of the National Society of Genetic Counselors

The objective of this document is to provide recommendations for genetic evaluation and counseling of couples with recurrent miscarriage (RM). The recommendations are the opinions of the multidisciplinary Inherited Pregnancy Loss Working Group (IPLWG), with expertise in genetic counseling, medical genetics, maternal fetal medicine, internal medicine, infectious disease, cytogenetics, and coagulation disorders. The IPLWG defines RM as three or more clinically recognized consecutive or non-consecutive pregnancy losses occurring prior to fetal viability (<24 weeks gestation). These recommendations are provided to assist genetic counselors and other health care providers in clinical decision-making, as well as to promote consistency of patient care, guide the allocation of medical resources, and increase awareness of the psychosocial and cultural issues experienced by couples with RM. The IPLWG was convened with support from the March of Dimes Western Washington State Chapter and the University of Washington Division of Medical Genetics. The recommendations are U.S. Preventive Task Force Class III, and are based on clinical experiences, review of pertinent English-language published articles, and reports of expert committees. This document reviews the suspected causes of RM, provides indications for genetic evaluation and testing, addresses psychosocial and cultural considerations, and provides professional and patient resources. These recommendations should not be construed as dictating an exclusive course of medical management, nor does the use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the circumstances of a specific case, should always supersede these recommendations.     

Improving the Rigor of Mechanistic Behavioral Science: The Introduction of the Checklist for Investigating Mechanisms in Behavior-Change Research (CLIMBR)

Diverse fields rely on the development of effective interventions to change human behaviors, such as following prescribed medical regimens, engaging in recommended levels of physical activity, getting vaccinations that promote individual and public health, and getting a healthy amount of sleep. Despite recent advancements in behavioral intervention development and behavior-change science, systematic progress is stalled by the lack of a systematic approach to identifying and targeting mechanisms of action that underlie successful behavior change. Further progress in behavioral intervention science requires that mechanisms be universally prespecified, measurable, and malleable. We developed the CheckList for Investigating Mechanisms in Behavior-change Research (CLIMBR) to guide basic and applied researchers in the planning and reporting of manipulations and interventions relevant to understanding the underlying active ingredients that do—or do not—drive successful change in behavioral outcomes. We report the rationale for creating CLIMBR and detail the processes of its development and refinement based on feedback from behavior-change experts and NIH officials. The final version of CLIMBR is included in full.     

T-PALS framework to assess children who stutter with coexisting disorders: A tutorial

The purpose of this paper is to present a tutorial on a diagnostic framework developed to assess children who stutter and exhibit co-existing disorders. While we have guidelines for treating these children, there are no specific guidelines for assessing them. We provide a rationale for the development of T-PALS with support from the literature. The T-PALS framework assesses 5 foundational key elements for the child: Temperament (T), Pragmatics (P), Articulation/phonology (A), Language (L), and Stuttering (S). Both qualitative and quantitative measures are used within each dimension. This framework is discussed with reference to using two clinical case examples. T-PALS observation data are presented as well as treatment suggestions for each case. We conclude that T-PALS may be a useful framework for both clinicians and researchers, working with children who present with stuttering and comorbid conditions. Clinicians are encouraged to reach beyond the traditional focus on solely assessing the stuttering behavior, even when that is the main concern for referral, and to consider a broader view of the child. It is hoped that this more integrative approach to assessment may yield a more holistic diagnostic picture of a dual diagnosis child from which treatment goals can be derived.