Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N = 114; Motivational Interviewing [MI]-enhanced parent-teen behavior therapy) of a community-based randomized trial of adolescent ADHD treatment. Participants received therapy from community clinicians (N = 44) at four agencies in a large, ethnically diverse metropolitan setting. Therapists provided self-report of session-by-session adherence to content fidelity checklists and audio recordings of sample sessions that were coded for MI integrity. Parents provided report of ADHD symptoms and family impairment at baseline, posttreatment, and follow-up, while academic records were obtained directly from the local school district. Results indicated that content fidelity significantly waned across the 10 manualized sessions (d = -1.23); these trends were steepest when therapy was delivered outside the office-setting and parent attendance was low. Community therapist self-report of content fidelity predicted significantly greater improvements in academic impairment from baseline to follow-up. MI delivery quality was not associated with improved outcomes; contrary to hypotheses, lower MI relational scores predicted significantly greater improvements in family impairment over time. Findings indicate that community-based outcomes for evidence-based ADHD treatment are enhanced when treatment is implemented with fidelity. Future work should revise community-based implementation strategies for adolescent ADHD treatment to prevent declines in fidelity over time, thereby improving outcomes.     

Within‐person Relationship between Creative Self‐efficacy and Individual Creativity: The Mediator of Creative Process Engagement and the Moderator of Regulatory Focus

Integrating the dynamic self‐regulatory framework with the motivational self‐regulation perspective, we theorize and test how and when creative self‐efficacy increases individual creativity at the within‐person level. Conceptualizing creative process engagement as a self‐regulation effort, we theorize that creative process engagement mediates the within‐person effect of creative self‐efficacy on individual creativity. We further explore how creative self‐efficacy and chronic regulatory focus interact to affect the within‐person mediating effect. A sample of 145 R&D workers provided two monthly reports for their creative activities and experiences over 8 months. The findings provide empirical support for the hypothesized mediating mechanism. At the within‐person level, creative process engagement mediates the relationship between creative self‐efficacy and individual creativity. The results also show that chronic regulatory focus moderated the mediated relationship. Specifically, creative self‐efficacy is positively related to individual creativity for employees with a strong prevention focus and negatively related to individual creativity for employees with a strong promotion focus.     

A self-efficacy enhancing intervention for pulmonary rehabilitation based on motivational interviewing for postoperative lung cancers patients: modeling and randomized exploratory trial

The objective of this study was to evaluate the feasibility and preliminary efficacy of a self-efficacy enhancing intervention designed for pulmonary rehabilitation based on motivational interviewing (MI) for postsurgical non-small cell lung cancer (NSCLC) patients. This study was a 2-arm pilot randomized controlled trial and was conducted in two cardiothoracic surgery departments, a tertiary hospital in Fuzhou, China. 28 postsurgical NSCLC patients were randomized to a 3 month (6 session) self-efficacy enhancing intervention based on MI or usual care (UC). Data were measured at baseline and after intervention. The MI based self-efficacy enhancing intervention group was superior to the UC group for reducing anxiety and depression, improving self-efficacy, quality of life, confrontational coping, social support and functional capacity. However, no statistically significant difference was observed in subjective well-being, posttraumatic growth, body mass index and pulmonary function between the two groups. This pilot study demonstrated the feasibility of MI based self-efficacy enhancing intervention for postsurgical NSCLC patients. A larger randomized trial would demonstrate a more rigorous test of efficacy.     

The role of vocational identity development and motivational beliefs in undergraduates’ student engagement

The present study examined the role of vocational identity processes and motivational beliefs among 216 undergraduates’ level of student engagement (affective, behavioural and cognitive). Through regression analysis, in-depth career exploration was found to be positively related to the student engagement variables, while career self-doubt emerged as a negative predictor. Identification with commitment was also found to be positively associated with students’ affective and cognitive engagement, but not behavioural engagement. Furthermore, students’ perceived value in academic activities played a critical role in mediating these relationships. Despite the significant associations, other vocational identity processes (in-breadth career exploration, commitment making and career flexibility) and motivational beliefs (competence beliefs and perceived cost) failed to act as predictors and mediators, respectively, as hypothesised. Nonetheless, the current findings demonstrate the importance of vocational identity development in undergraduate students’ learning, and suggest a need for more identity interventions or career counselling services in college and pre-university contexts.     

Motivational systems of agonistic behavior in muroid rodents: A comparative review and neural model

The data on agonistic behavior of muroid rodents that have been obtained from field observations and laboratory experiments are reviewed and compared in terms of a hypothetical model of the neural organization of these behaviors. The neural model has been presented elsewhere and is used here only as a way to organize the data. The data are organized in terms of four hypothetical motivational systems: Offense, defense, submission, and patrol/marking. The various behaviors are considered as motor patterns and are compared and analyzed in terms of the proposed motivating, releasing, and directing stimuli of the motivational systems. Interactions and overlaps between the motivational systems are also considered. It is concluded that the organization of agonistic behavior may be similar across all species of muroid rodents. Generalizations are complicated by the profound effects of ontogenetic factors. Four categories of behaviors differ from species to species: Scent-marking, submissive behaviors, threat behaviors, and alarm signals. The possible phylogenetic and ontogenetic factors in these differences are considered.     

Difficult Terminations in Group Therapy: A Self Psychologically Informed Perspective

In group therapy, terminations that are neither planned nor anticipated are sometimes referred to as difficult. This complex issue of difficult terminations is used as a vehicle to challenge the prevailing, though often unspoken, assumption that the goal of the group therapist is to keep the members in the group. The author presents the notion that the leader needs to maintain a balance between the group as a treatment context, and the goal of that context. The goal of group-as-treatment context is to provide for the therapeutic needs of each individual patient in the group. Self psychology provides a basis for redefining the therapy group as a treatment context. A specific rationale, goal, and process of that redefinition is presented along with illustrative case material. With this understanding, unanticipated terminations can be as readily accepted and understood as ones that are planned. All terminations are viewed as further opportunities to understand how a patient defines his or her sense of self, sense of other, and sense of self with other.     

急性疼痛与慢性疼痛对奖赏加工的影响及神经机制

疼痛和奖赏能够为个体提供不同的行为动机和主观价值体验,寻求奖赏和避免疼痛对于生存都很重要。疼痛可划分为急性疼痛和慢性疼痛,奖赏可区分为预期阶段的动机成分和体验阶段的享乐成分。奖赏对疼痛的抑制作用已经被广泛证实,但关于疼痛对奖赏的影响,目前的研究结果并不一致。因此需要进一步区分并探究急性疼痛与慢性疼痛对奖赏加工不同阶段的影响,分析两种疼痛对奖赏加工产生不一致影响的现象。这种现象出现的原因可能与急性疼痛向慢性疼痛转变过程中出现的奖赏加工能力缺陷有关。未来可以考虑从改善奖赏加工能力缺陷的角度进行检测和治疗,提前预防急性疼痛向慢性疼痛转变。     

Motivational intensity modulates the effects of positive emotions on set shifting after controlling physiological arousal

Recent research on the construct of emotion suggests the integration of a motivational dimension into the traditional two‐dimension (subjective valence and physiological arousal) model. The motivational intensity of an emotional state should be taken into account while investigating the emotion‐cognition relationship. This study examined how positive emotional states varying in motivational intensity influenced set shifting, after controlling the potential confounding impacts of physiological arousal. In Experiment 1, 155 volunteers performed a set‐shifting task after being randomly assigned to five states: high‐ vs. low‐motivating positive affect (interest vs. serenity), high‐ vs. low‐motivating negative affect (disgust vs. anxiety), and neutral state. Eighty‐five volunteers participated in Experiment 2, which further examined the effects of higher vs. lower degree of interest. Both experiments measured and compared participants' physiological arousal (blood pressure and pulse rate) under the normal and experimental conditions as the covariate. Results showed no difference in switching performance between the neutral and serenity groups. As compared with the neutral state, the high‐motivating positive affect significantly increased set‐switching reaction time costs, but reduced error rate costs; the higher the motivational intensity, the greater the time‐costs impairment. This indicates a role of the high‐motivating positive affect in regulating the balance between the flexible and stable cognitive control. Motivational intensity also modulated the effects of negative emotional states, i.e., disgust caused a larger increase in time costs than anxiety. Further exploration into neurobiological mechanisms that may mediate the emotional effects on set shifting is warranted.