Reducing emergency medical service use in patients with chronic psychotic disorders: results from the FAST intervention study

Patients with schizophrenia have disproportionately high rates of emergency medical service use, likely contributing to the high cost this illness places on society. The aim of this study was to examine the impact of a theory-based, behavioral intervention on immediate and long-term use of emergency medical services. Older patients with schizophrenia (n=240) were randomized to receive either a behavioral, skills-building intervention known as Functional Adaptation and Skills Training (FAST) or a time-equivalent attention-control condition (AC). Logistic regression analyses indicated that AC participants were nearly twice as likely to use emergency medical services in general (OR=2.54; p=0.02) and emergency psychiatric services in particular (OR=3.69; p=0.05) during the active intervention phase of the study. However, there were no differences between the interventions in terms of emergency service use during the long-term follow-up phase of the study (i.e., 6-18 months post-baseline). The FAST intervention appears efficacious for reducing the short-term risk of using emergency medical services. However, the long-term efficacy of the FAST intervention appears less clear. Future studies may want to provide more powerful maintenance sessions to encourage continued use of skills in patients' real-world settings.     

Representation over time: the effects of temporal distance on similarity

Similarity is central in human cognition, playing a role in a wide range of cognitive processes. In three studies, we demonstrate that subjective similarity may change as a function of temporal distance, with some events seeming more similar when considered in the near future, while others increase in similarity as temporal distance increases. Given the ubiquity of inter-temporal thought, and the fundamental role of similarity, these results have important implications for cognition in general.     

Expectation-based syntactic comprehension

This paper investigates the role of resource allocation as a source of processing difficulty in human sentence comprehension. The paper proposes a simple information-theoretic characterization of processing difficulty as the work incurred by resource reallocation during parallel, incremental, probabilistic disambiguation in sentence comprehension, and demonstrates its equivalence to the theory of Hale [Hale, J. (2001). A probabilistic Earley parser as a psycholinguistic model. In Proceedings of NAACL (Vol. 2, pp. 159-166)], in which the difficulty of a word is proportional to its surprisal (its negative log-probability) in the context within which it appears. This proposal subsumes and clarifies findings that high-constraint contexts can facilitate lexical processing, and connects these findings to well-known models of parallel constraint-based comprehension. In addition, the theory leads to a number of specific predictions about the role of expectation in syntactic comprehension, including the reversal of locality-based difficulty patterns in syntactically constrained contexts, and conditions under which increased ambiguity facilitates processing. The paper examines a range of established results bearing on these predictions, and shows that they are largely consistent with the surprisal theory.     

Leadership and regressive group processes: A pilot study

Various perspectives on leadership within the psychoanalytic, organizational and socio‐biological literature are reviewed, with particular attention to research studies in these areas. Hypotheses are offered about what makes an effective leader: her ability to structure tasks well in order to avoid destructive regressions, to make constructive use of the omnipresent regressive energies in group life, and to redirect regressions when they occur. Systematic qualitative observations of three videotaped sessions each from N = 18 medical staff work groups at an urban medical center are discussed, as is the utility of a scale, the Leadership and Group Regressions Scale (LGRS), that attempts to operationalize the hypotheses. Analyzing the tapes qualitatively, it was noteworthy that at times (in N = 6 groups), the nominal leader of the group did not prove to be the actual, working leader. Quantitatively, a significant correlation was seen between leaders’ LGRS scores and the group’s satisfactory completion of their quantitative goals (p = 0.007) and ability to sustain the goals (p = 0.04), when the score of the person who met criteria for group leadership was used.     

The path or the goal? Decision vs. information focus in biased information seeking after preliminary decisions

Research on the phenomenon of selective exposure to information demonstrates that after preliminary or final decisions, people show a preference for supporting rather than conflicting information (confirmation bias). In this article, we examine conditions that increase or decrease distortions in the search for information. We report on four experiments indicating that the confirmation bias is influenced by whether people focus on their decision or on the presented pieces of information during the information search. Focusing on the decision, for example, because a reward for a correct decision is promised or simply because participants repeatedly think of it, increases the confirmation bias. On the other hand, if participants focus on the available pieces of information because they have to invest money in order to search for information or because they have to evaluate the individual pieces of information, the confirmation bias decreases. Implications for theoretical understanding and interventions for decision-making situations are discussed.     

Uncovering an existential barrier to breast self-exam behavior

The present research applies an analysis derived from terror management theory to the health domain of breast examination, and in doing so uncovers previously unrecognized factors that may contribute to women’s reluctance to perform breast self-examinations (BSEs). In Study 1, when concerns about mortality were primed, reminders of human beings’ physical nature (i.e., creatureliness) reduced intentions to conduct BSEs compared to reminders of humans’ uniqueness. In Study 2, women conducted shorter exams on a breast model (an experience found to increase death-thought accessibility) when creatureliness was primed compared to a uniqueness and no essay condition. In Study 3, after a creatureliness prime, women performed shorter BSEs when a placebo did not provide an alternative explanation for their discomfort compared to when it did. Advances for theory and breast self-exam promotion are discussed.     

Evidence for the DTA hypothesis II: Threatening self-esteem increases death-thought accessibility

Three studies assessed the impact of self-esteem threat on death-thought accessibility (DTA). Increased DTA resulted from three distinct types of self-esteem threat. Studies 1 and 2 employed negative feedback procedures in which participants were told that they scored below average on an intelligence test (Study 1), or that their personality was incongruent for their desired career path (Study 2). In Study 3, participants were led to believe that they would give an ill prepared speech in front of their peers. In Studies 1 and 2 DTA was assessed via reaction times on a lexical decision task, while Study 3 employed a word-fragment completion task. Study 3 demonstrated the DTA buffering effect of fortifying self-esteem via self-affirmation. Discussion focused on general implications for TMT, self-esteem, and mental health.     

It’s not just what you say but when you say it: Self-presentation and temporal construal

Three experiments demonstrated that the use and effectiveness of self-presentation strategies are affected by time. In Experiment 1, participants used more indirect self-presentation statements for the distant than near future, but used more direct self-presentation statements for the near than distant future. In Experiment 2, participants for whom indirect self-presentation strategies were made accessible rated a future interview as more temporally distant than those for whom direct self-presentation strategies were made accessible. In Experiment 3, participants rated their self-presentation attempts as more effective if they used direct strategies for the near future and indirect strategies for the distant future. Implications for studying the timing of self-presentation and its relation to temporal construal levels are discussed.     

Inferring latent class lexicographic rules from choice data

A lexicographic rule orders multi-attribute alternatives in the same way as a dictionary orders words. Although no utility function can represent lexicographic preference over continuous, real-valued attributes, a constrained linear model suffices for representing such preferences over discrete attributes. We present an algorithm for inferring lexicographic structures from choice data. The primary difficulty in using such data is that it is seldom possible to obtain sufficient information to estimate individual-level preference functions. Instead, one needs to pool the data across latent clusters of individuals. We propose a method that identifies latent clusters of subjects, and estimates a lexicographic rule for each cluster. We describe an application of the method using data collected by a manufacturer of television sets. We compare the predictions of the model with those obtained from a finite-mixture, multinomial-logit model.     

LÉVY HIERARCHY IN WEAK SET THEORIES

We investigate the interactions of formula complexity in weak set theories with the axioms available there. In particular, we show that swapping bounded and unbounded quantification preserves formula complexity in presence of the axiom of foundation weakened to an arbitrary set base, while it does not if the axiom of foundation is further weakened to a proper class base. More attention is being paid to the necessary axioms employed in the positive results, than to the combinatorial strength of the positive results themselves.