Evaluating discrete trial teaching with instructive feedback delivered in a dyad arrangement via telehealth

Telehealth research in the field of applied behavior analysis (ABA) has focused on the training and supervision of others to implement various behavior analytic procedures. Current guidelines for practicing telehealth suggest that direct telehealth services may be appropriate for some individuals diagnosed with autism spectrum disorder, but more research is needed. This study evaluated the effects of discrete trial teaching with instructive feedback in a dyad arrangement delivered directly via telehealth to teach tact relations to 6 children diagnosed with autism spectrum disorder. All participants and the experimenter were located in different physical locations. All participants learned their primary and secondary targets, and 5 of the participants acquired the observational primary and secondary targets without direct teaching. Areas of future research and clinical implications are discussed in the context of telehealth service delivery.     

Photographic Assessment of Change in Trichotillomania: Psychometric Properties and Variables Influencing Interpretation

Although photographic assessment has been found to be reliable in assessing hair loss in Trichotillomania, the validity of this method is unclear, particularly for gauging progress in treatment. The current study evaluated the psychometric properties of photographic assessment of change in Trichotillomania. Photographs showing hair loss of adults with Trichotillomania were taken before and after participating in a clinical trial for the condition. Undergraduate college students (N?=?211) rated treatment response according to the photos, and additional archival data on hair pulling severity and psychosocial health were retrieved from the clinical trial. Photographic assessment of change was found to possess fair reliability (ICC?=?0.53), acceptable criterion validity (r?=?0.51), good concurrent validity (r?=?0.30–0.36), and excellent incremental validity (ΔR ²?=?8.67, p?<?0.01). In addition, photographic measures were significantly correlated with change in quality of life (r?=?0.42), and thus could be considered an index of the social validity of Trichotillomania treatment. Gender of the photo rater and pulling topography affected the criterion validity of photographic assessment (partial η ²?=?0.05–0.11). Recommendations for improving photographic assessment and future directions for hair pulling research are discussed.     

Evaluation of a Brief Mindfulness Program for People with Multiple Sclerosis Delivered in the Community Over Five Years

This study evaluated the effectiveness, change mechanisms, and sustainability of a brief mindfulness intervention for people with multiple sclerosis (PwMS) delivered in the community through a frontline service over five years. Participants were 126 PwMS. A single intervention condition design was used with pre-intervention, post-intervention and 2-month follow-up assessments. The primary outcome was distress. Secondary outcomes were perceived stress, quality of life (QoL) and fatigue, and the proposed change mechanisms: mindfulness, self-compassion, psychological inflexibility. Intention-to-treat analyses showed the primary outcome, distress (Cohen’s d = .25), and all secondary outcomes improved: perceived stress (d = .38), mental health QoL (d = .39), physical health QoL (d = .47), fatigue (d = .30), mindfulness (d = .29), self-compassion (d = .37), psychological flexibility (d = .44). Distress, stress and perceived stress continued to improve post-intervention to follow-up. Mindfulness emerged as a temporal mediator of perceived stress (BCa 95% CI). Self-compassion mediated concurrent improvements in distress, perceived stress, fatigue and physical health QoL, while greater psychological flexibility mediated concurrent reductions in distress (BCa 95% CI). Mindfulness home practice was unrelated to improvements on all outcomes except a marginal association with mindfulness. Of the socio-demographic and illness factors, lower disease severity predicted improvements in physical health QoL (p = .046). Improvements in outcomes were supported by qualitative feedback and participant satisfaction ratings. Twenty-one groups were offered with good participant engagement and wide geographical reach, suggesting sustained feasibility of the Mindfulness for MS program over five years. Findings support the delivery of the Mindfulness for MS program through a community-based service in partnership with a local university.

     

When is the gift given? Organ donation,social representations,and an opportunity to register

The gift of life doctrine underpins Australia's approach to organ donation: in legislation, clinical practice, community awareness campaigns, and educational activities. In this paper, we present an approach that situates an understanding of organ donation within a social representation framework as a system of values, ideas, and practices. In cadaveric donation, the final giving‐of‐the‐gift can never be by the donor, leading us to ask where the potential donor's decision to give the gift really lies. We present research from three studies that explored the relationship between what was socially understood about organ donation and the registration of donation intent. Drawing from three socially and culturally diverse populations, we asked people working in a corporate city institution and those attending two football matches in the outer city area to complete a word‐association task and Likert‐scale belief questions about organ donation—followed by an opportunity to register immediately on the Australian Organ Donor Register. Driven by the interdependent themata of life/death and self/other, the gift of life doctrine is inextricably linked with the loss of life emerging as both positive and negative beliefs allowing their relationship to actual registration behaviour to be observed. Our findings suggest that in many instances, the potential donor's genuine desire to give the gift lies in the tension between positive and negative beliefs, manifesting as a consent registration when the positive beliefs about donation prevail and an immediate opportunity to register is available.     

The Integrated Therapy of Family Members—A Case Report

Winnicott's concept of the “transitional space” is used in an effort to develop a conceptual unity between intra- and interpersonal dynamics. It is proposed that in their work together, the members of a therapy group develop a shared psychic “group space” derivative from the interaction of the “transitional space” of each, and within which the actual interpersonal transactions and influences take place. Possible underlying bases for such a theoretical concept are considered, as well as its implications for group therapy.     

The structure of the Hospital Anxiety and Depression Scale: Theoretical and methodological considerations

The Hospital Anxiety and Depression Scale (HADS; Zigmond - Snaith, 1983) is widely used; however, its factor structure is unclear, with studies reporting differing unidimensional, two-factor and three-factor models. We aimed to address some key theoretical and methodological issues contributing to inconsistencies in HADS structures across samples. We reviewed existing HADS models and compared their fit using confirmatory factor analysis (CFA). We also investigated methodological effects by comparing factor structures derived from Rasch and Principal Components Analysis (PCA) methods, as well as effects of a negative wording factor. An Australian community-dwelling sample consisting of 189 females and 158 males aged 17–86 (M = 35.73, SD = 17.41) completed the 14-item HADS. The Rasch Analysis, PCA and CFA all supported the original two-factor structure. Although some three-factor models had good fit, they had unacceptable reliability. In the CFA, a hierarchical bifactor model with a general distress factor and uncorrelated depression and anxiety subscales produced the best fit, but the general factor was not unidimensional. The addition of a negative wording factor improved model fit. These findings highlight the effects of differing methodologies in producing inconsistent HADS factor structures across studies. Further replication of model fit across samples and refinement of the HADS items is warranted.