Giving meaning to illness: An investigation of self-defining memories in patients with relapsing-remitting multiple sclerosis patients

Multiple sclerosis (MS) patients are often unable to adequately fulfill their established roles due to physical disabilities and cognitive changes, making this chronic illness particularly threatening to personal identity. Twenty-five MS patients and 25 healthy controls were asked to recall five self-defining memories (SDM). Overall characteristics of SDM did not differ between patients and controls; MS patients displayed preserved capacity to draw meaning upon past events. Moreover, almost two-thirds of MS patients mentioned at least one illness related SDM and about 25% of patients’ SDM referred to MS. These memories were experienced as more negative and associated with more tension than other SDM but led toward more positive emotion and less negative emotion over time; they were also more central and more integrated to the personal identity. We concluded that self-challenging events due to MS may trigger both cognitive and emotional processes enabling the integration of illness in patients’ self-representations.     

Who uses community mental health centres? A study of one health district

A caseload analysis was undertaken to investigate those clients seen by five community mental health centre teams within one healthcare district. The 985 clients are described in terms of demographic and clinical features and questions relating to service provision are discussed.     

Daily stress and anxiety and their relation to daily fluctuations of symptoms in asthma and chronic obstructive pulmonary disease (COPD) patients

Although stress and anxiety have long been assumed to play an exacerbatory role in asthma, no study has systematically documented that daily exacerbations of asthma symptoms are related to stress and/or anxiety. In this study, 24 airways obstruction patients (12 asthmatics and 12 chronic obstructive pulmonary disease patients) were instructed to monitor the severity of daily respiratory symptoms. In addition, subjects recorded their daily anxiety level and the number and perceived impact of daily stressors. The results showed that although there were differences between high- and low-stress days for both groups, there were no differences between groups on symptom severity or between high- and low-anxiety days, as measured by the State-Trait Anxiety Inventory (STAI). Thus, although the number and impact of daily stressors were found to be directly associated with the severity of asthma symptoms, anxiety does not appear to have a direct role in the exacerbation of asthma. The findings failed to support the anxiety theory of asthma but provided an explanation for the poor results obtained in previous treatment studies which employed anxiety management with asthmatics.     

Reciprocal peer management: Improving staff instruction in a vocational training program

To test the feasibility and utility of involving peers as sources of feedback, 6 subjects, instructors in a vocational program for adults with mental retardation, participated in a staff training and management program. Subjects' teaching interactions were assessed during baseline, in-service training (on effective teaching), return-to-baseline, peer management, and follow-up phases. Peer management was introduced in multiple baseline fashion across pairs of subjects. Members of each pair were trained to monitor peer teaching, to record and graph data, to provide feedback, and to set goals with the peer. Each pair then performed these procedures on the job for several weeks, during which time 4 of the 6 subjects increased their use of effective teaching methods (over baseline). However, inconsistencies in the magnitude and durability of these increases require that the study be viewed as inconclusive, although it has heuristic value as a promising model for involving co-workers in staff management programs.     

Comparison of simultaneous prompting and constant time delay procedures in teaching sight words to elementary students with moderate mental retardation

Simultaneous prompting (a type of antecedent prompt and test procedure) and constant time delay were compared with four students with moderate mental retardation learning expressive sight words. A parallel treatments design across word sets and replicated across students was used. For acquisition, the simultaneous prompting procedures required fewer trials, sessions, and training time to criterion and resulted in fewer student errors during daily probe and training sessions. However, maintenance data indicated mixed results across the two procedures. Reliability data (both dependent and independent variables) revealed no differences between the two procedures in terms of the teacher's accuracy in recording student responses and implementing each procedure. Future research issues are discussed.     

Delayed constructed-response identity matching improves the spelling performance of students with mental retardation

We assessed the effects of a computerized matching-to-sample procedure on the spelling performances of three students with mental retardation. Initially, the students could 1) match pictures and printed words to one another, and 2) match pictures and printed words to spoken words. However, they could not construct words to either pictures or spoken words (e.g., touch, in order, the letters s->h->o->e given the spoken-word sample Shoe). Word constructions then improved markedly after exposure to delayed constructed-response identity matching (e.g., touch the letters s->h->o->e given the printed-word sample shoe). One subject's oral and written spelling also improved. The results extend previous research by showing multiple positive effects of a computerized spelling intervention. These effects may have occurred in part because of the formation of stimulus classes among pictures, printed words, and spoken words.     

GENERALIZED LANGUAGE LEARNING BY CHILDREN WITH SEVERE MENTAL RETARDATION: EFFECTS OF PEERS' EXPRESSIVE MODELING

In this study, we investigated the conditions that contribute to observational learning of generalized language in children with severe mental retardation. Matrix-training strategies were used to teach 6 children with mental retardation to combine known words into two- or three-word utterances consistent with syntactic rules. Subsequently, the children learned two or more unknown words concurrently, inducing word-referent relations consistent with these word order rules. Generalized learning of responses not taught directly was shown to be under experimental control using a multiple baseline design across submatrices. Expressive modeling of only four or five responses was sufficient to promote recombinative generalization in the expressive and receptive modalities. Thus, 95% to 98% of subjects' learning was attributed to generalization processes. This study demonstrates how the efficiency of language training with children with mental retardation might be enhanced by coupling observational learning and matrix-training strategies.     

TEACHING SUPPORTED EMPLOYEES WITH SEVERE MENTAL RETARDATION TO SOLVE PROBLEMS

Two individuals with severe mental retardation, employed by a janitorial supply company, were taught to use self-instruction in combination with multiple exemplar training to solve work-related problems. Use of the combined strategy resulted in generalization of the effects of independent variables, as well as generalization to nontrained problems. Use of the strategy is discussed in terms of promoting independent performance among supported employees.     

PRODUCING GENERALIZED JOB INITIATIVE IN SEVERELY MENTALLY RETARDED SHELTERED WORKERS

The development of generalized job initiative was examined with three severely retarded men working in an industrial assembly area of a sheltered workshop. Interventions included discrimination training, role-play training, and self-monitoring. For each participant, training was applied sequentially to three sets of job initiative behaviors. Intensive training was required to establish the first set of job initiative behaviors; however, the second and third sets of job initiative behaviors were learned with only discrimination training. The discussion summarizes the findings and suggests research needed to develop more powerful learning-to-learn paradigms.