Brief report: A clinical tracking system for helping see the forest through the trees

Adults with developmental disabilities who display behavior disorders repressent some of our field's biggest challenges. Those who provide direct support for such individuals are sometimes frightened and often frustrated by the occurrence of these behaviors parrticularly if neither they nor the agencies for whom they work have been successful in alleviating them. Under such circumstances the agency may secure the services of a consultant. At such times the consultant may find it diffcult to obtain information [from which to generate plausible hypothese and design interventionl plans] that is not unduly influenced by the emotions of the moment. This article describes a stop-gap system that can be used under such circumstsances to gather and analyze valuable longitudinal behavioual ecological data. The basic assumptions and strategies of this system are explained and illustrated through three case studies.     

Identifying illness perception schemata and their association with depression and quality of life in cardiac patients

The purpose of this paper is to identify groups of cardiac patients who share similar perceptions about their illness and to examine the relationships between these schemata and psychosocial outcomes such as quality of life and depression. A total of 190 cardiac patients with diagnoses of myocardial infarction, stable angina pectoris or chronic heart failure, completed a battery of psychosocial questionnaires within four weeks of their admission to hospital. These included the Brief Illness Perceptions Questionnaire (BIPQ), Beck Depression Inventory II (BDI II) and The MacNew Health-related Quality of Life instrument (MacNew). BIPQ items were subjected to latent class analysis (LCA) and the resulting groups were compared according to their BDI II and MacNew scores. LCA identified a five-class model of illness perception which comprised the following: (1) Consequence focused and mild emotional impact, n?=?55, 29%; (2) Low illness perceptions and low emotional impact, n?=?45, 24%; (3) Control focused and mild emotional impact, n?=?10, 5%; (4) Consequence focused and high emotional impact, n?=?60, 32%; and (5) Consequence focused and severe emotional impact, n?=?20, 10%. Gender and diagnosis did not appear to reflect class membership except that class 2 had a significantly higher proportion of AMI patients than did class 5. There were numerous significant differences between classes in regards to depression and health-related quality of life. Notably, classes 4 and 5 are distinguished by relatively high BDI II scores and low MacNew scores. Identifying classes of cardiac patients based on their illness perception schemata, in hospital or shortly afterwards, may identify those at risk of developing depressive symptoms and poor quality of life.     

Assessment of the Effectiveness of Genetic Counseling by Telephone Compared to a Clinic Visit

Maternal serum screening, also known as the triple screen, is used during pregnancy to assess the risk of carrying a fetus with specific chromosome abnormalities or open spina bifida. All women in British Columbia who screen positive are eligible for genetic counseling and are offered amniocentesis. The purpose of this study is to determine what differences (if any) exist in patients' understanding and/or anxiety when genetic counseling for a positive triple screen is conducted in person versus over the telephone. Each patient who participated was given the choice of having genetic counseling in person or over the telephone, this after a randomized design failed to elicit any participants. Using a written postcounseling questionnaire, each patient was assessed for her understanding of the information presented in the session, and her anxiety regarding her risk. In this small pilot study, no large differences were detected in patients' understanding or anxiety when genetic counseling was conducted by telephone versus in person.     

Disease controllability moderates the effect of coping efficacy on positive affect

Objective: This study aims to test experimentally whether coping strategies (approach- vs. avoidance-oriented coping) have differential effects under conditions of high or low stressor controllability.

Design: Undergraduates (62 women, 30 men) participated in a 2 × 2 experimental study where they were introduced to a fictitious disease (tisomerase enzyme deficiency) said to be either controllable or uncontrollable and an approach- or avoidance-oriented coping behaviour induction.

Main Outcome Measures: Changes in positive and negative affect.

Results: A significant disease control x coping interaction on positive affect (f² = .07, p = .011) revealed that approach-coping condition participants had higher positive affect than avoidance-coping condition participants when disease control was high (d = .94, p = .003), but not when it was low (d = .11, p = .93). The experimental conditions did not significantly influence negative affect.

Conclusion: Results demonstrate that disease control moderates the salubrious effects of approach-oriented coping on positive affect. For controllable, but not uncontrollable, health stressors, promoting problem-focused approach-oriented coping strategies may be recommended.     

Mirror image arm used in monocular, binocular, and blindfolded pointing

Observers were instructed to point with their right arm to a mirror image of their left shoulder. Instead of pointing to the target with their real arm, they occluded the target with their mirror-imaged finger, and their real finger pointed off to the left side of the target, facts that came as a surprise to them in debriefing. The occlusion by a mirror image finger was not done to avoid double images, since it occurred in monocular conditions. That it is due to planning before pointing can be inferred from the fact that it occurred in blindfolded conditions.