Positive Affect: A Neglected Group Treatment Outcome Measure in Assessing Efficacy of Psychosocial Group Interventions in Individuals with Heart Failure

Positive affect has been neglected in evaluation of group treatment efficacy. This pilot study for individuals with heart failure illustrates the contribution of positive affect to change processes. Assessment of positive affect pre- and post-group intervention can yield a better understanding of individuals' adjustment to heart failure, and provide additional information for selection of specific treatments for each individual. In an era characterized by standardized measures of outcome, inclusion of positive affect provides additional opportunity to document contributions in improving health related quality of life (psychosocial and physical functioning) of clients with heart failure.     

Change in the Psychological Adjustment of Children with Cystic Fibrosis or Sickle Cell Disease and Their Mothers

Objectives: This study has three interrelated objectives: (1) to track the adjustment of children and adolescents with sickle cell disease (SCD) or cystic fibrosis (CF) and their mothers through a third assessment point 2 years after the initial assessment; (2) to determine whether the adaptational processes of the transactional stress and coping model associated with adjustment at the initial assessment continue to be associated with adjustment 2 years later; and (3) to determine whether the pattern of association of adaptational processes with adjustments differs by illness subgroup. Methods: The study samples included 59 children with CF and 50 children with SCD and their mothers. Measures were obtained on maternal adjustment and appraisals of daily and illness stress, coping methods, and family functioning. Child measures included child-reported and mother-reported child adjustment and child perceptions of self-worth and health locus of control and pain coping methods. Results: Consistency in adjustment classification was only 31–32% for child self-report, 66% for mother-reported child behavior problems, and 56–77% for mother self-reported adjustment for the CF and SCD groups, respectively. Support was provided for the association of adaptational processes with maternal adjustment and with the adjustment of children with SCD but not for children with CF. Conclusion: The stability of adjustment has implications for prevention and treatment intervention and subsequent research steps. Intervention efforts should be focused on the relatively small subgroups of children with chronic illnesses and their mothers with consistently poor adjustment.     

Recognition failure and integration

If a recognition test is followed by a cued recall test then the probability of recognition given recall generally follows the Tulving-Wiseman function. Despite this regularity two types of exceptions have been discovered. Both poor integration and cue overlap causes an observed value of recognition given recall that is higher than predicted. The present study explores the first type of exception by proposing and testing an analytical tool, which emanates from confidence ratings given to recall responses, for relating poor integration directly to variations in the degree of deviation from the function. It is demonstrated that very poor integration produces a deviation above the function, whereas a very good integration produces a deviation below the function. The effect of integration (and cue overlap) is explained by means of a conceptualization cue dependency. Support is also given to the notion that an enhanced variability of goodness of encoding contributes to an enhanced dependence between recall and recognition.     

ESTABLISHMENT OF NONDELUSIONAL RESPONSES IN A SOCIALLY WITHDRAWN CHRONIC SCHIZOPHRENIC1

Multiple treatment interventions including instructions, modelling, timeout, avoidance of repetition, and reinforcement were successful in establishing factual answers to personal background questions in a withdrawn and socially unresponsive chronic schizophrenic. The subject had previously persisted in giving only delusional responses to these questions. A multiple-baseline design across verbal replies to personal background questions demonstrated that the changes in behavior were brought about by the treatment interventions. During baseline, the subject was reinforced for any response to four questions. The experimental interventions were then introduced for the first question and moved sequentially to an additional question when the subject's responses reached the criterion of at least 80% correct for two consecutive sessions. Introduction of the experimental interventions produced an increase from a baseline level of zero to at least 80% correct for each question. The use of the token reinforcement procedure was faded out after the subject was able to answer all four questions correctly at least 80% of the time for two consecutive sessions. Fading of the token reinforcement procedure was accomplished by using increasingly intermittent schedules of token reinforcement during the last seven sessions. In the final session, no tokens were used to reinforce the subject's responding. Nine-, ten-, and 12-month followup interviews were conducted to evaluate the maintenance of treatment gains. Maintenance was found to be complete at the nine- and 10-month followups, but at the 12-month followup interview, the subject answered one question incorrectly. This study replicates an investigation previously reported in this journal.     

The development of the multidimensional locus of pain control questionnaire (MLPC): Factor structure,reliability, and validity

This study was conducted to develop a comprehensive Multidimensional Locus of Pain Control questionnaire (MLPC) and to examine how locus of pain control is related to pain appraisals, pain coping strategies, and adjustment to chronic pain. Subjects were 170 chronic headache patients. By means of factor analysis, four subscales were derived: an Internal, a Chance, a Physician, and a Medication locus of pain control orientation scale. The reliability and validity of the subscales appeared to be satisfactory. The results of the present study indicate that the locus of pain control orientation is significantly related to pain appraisals such as perceived pain control and catastrophizing and, to a lesser degree, to coping strategies as measured by the Coping Strategies Questionnaire (CSQ). However, almost no relationship was observed between locus of pain control and adjustment to pain. Further research with the MLPC in different chronic pain populations is warranted in order to investigate whether the results found in this study can be generalized to chronic pain patients in general.     

Chronic pain relief after receiving affective touch: A single case report

Affective touch is gentle slow stroking of the skin, which can reduce experimentally induced pain. Our participant, suffering from Parkinson's Disease and chronic pain, received 1 week of non-affective touch and 1 week of affective touch as part of a larger study. Interestingly, after 2 days of receiving affective touch, the participant started to feel less pain. After 7 days, the burning painful sensations fully disappeared. This suggest that affective touch may reduce chronic pain in clinical populations.     

Quality of Well-Being Scale and Chronic Low Back Pain

Outcome measures that assess quality of life for use in health policy decisions need to be investigated in chronic pain patients. In the present study, the validity of the Quality of Well-Being Scale (QWB) was evaluated on 67 adult chronic low back pain (CLBP) patients who were enrolled in a 12-week multidisciplinary pain treatment program. Participants completed the QWB, a battery of pain measures, a behavioral observation task, and a medical exam. The findings indicated that CLBP patients have a low level of functioning or quality of life (M = .567, SD = .08) compared with persons with life-threatening diseases. The QWB score was significantly correlated with observational measures of pain behavior and pain-related coping strategies. Multivariate analysis indicated that interference in daily activities, distorted ambulation, affective distress, pain duration, and guarding were the most significant predictors of quality of well-being (multiple R = .84, p < .0001). Patients with medically incongruent physical signs had significantly lower QWB scores than patients with congruent signs. Overall, the data supported the validity of the QWB in a sample of CLBP patients.     

Spouses' responses to the dietary nonadherence of their partners managing diabetes

The association between patients' dietary nonadherence and spouses' involvement in patients' diabetes diet was examined, with spouses' anxiety about nonadherence considered as a mediator of this association. Daily diary data from 128 older adult patients with type 2 diabetes and their spouses were analyzed using multilevel models. Results revealed that on days when patients reported less adherence to their diabetes diet than usual, spouses reported greater anxiety about patients' diabetes management, which, in turn, was related to greater spousal persuasion and pressure the same day. The association between patients' nonadherence and diet‐related support on the same day was not mediated, however, through spouses' anxiety. The findings contribute to an understanding of spouses' responses to patients' nonadherence to their diabetes regimen.     

Emergent literacy skills and training time uniquely predict variability in responses to phonemic awareness training in disadvantaged kindergartners

The factors that predicted variability in responses to phonemic awareness training were investigated in kindergartners who live in poverty. Treatment children (n=42) received both analytic and synthetic phonemic awareness computer-assisted instruction, while controls (n=34) received no special training. Mean age of participants was approximately 5 years 7 months. Pretests included initial phonemic awareness, letter knowledge, word-level reading, invented spelling, vocabulary knowledge, and print concepts. Spelling skills emerged as the best consistent predictor of variability in phonemic awareness in response to instruction. We propose that relations between phonemic awareness and spelling skills are bidirectional: Spelling influenced growth in phonemic awareness and phonemic awareness contributed to growth in spelling skills. The amount of exposure that children had to the treatment intervention contributed uniquely to individual differences in posttest levels of phonemic awareness and spelling.     

Do Internet‐Based Support Interventions Change Perceptions of Social Support?: An Experimental Trial of Approaches for Supporting Diabetes Self‐Management

Internet-based support groups are a rapidly growing segment of mutual aid programs for individuals with chronic illnesses and other challenges. Previous studies have informed us about the content of online exchanges between support group members, but we know little about the ability of these interventions to change participants' perceptions of support. A randomized trial of 160 adult Type 2 diabetes patients provided novice Internet users with computers and Internet access to 1 of 4 conditions: (a) diabetes information only, (b) a personal self-management coach, (c) a social support intervention, or (d) a personal self-management coach and the support intervention. After 3 months, individuals in the 2 support conditions reported significant increases in support on a diabetes-specific support measure and a general support scale. Participants' age was significantly related to change in social support, but intervention effects were still significant after accounting for this relationship. This report is a critical first step in evaluating the long-term effects of Internet-based support for diabetes self-management. The discussion identifies directions for future research.