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 Degree Discipline: Health Psychology and Behavioral Medicine
The Role of Spirituality in Ethnic Minority Patients with Copd
COPD is the third leading cause of death in the United States and is the sixth leading cause of death for low-to middle income countries (Downs & Appel, 2006; GOLD, 2011). COPD is a largely preventable disease due to the lifestyle factors that heavily contribute to disease onset and severity. Although traditionally COPD research has focused on health outcomes related to risk factors, compliance, comorbid psychological and physical conditions, and treatment interventions, a growing body of research suggests religious and spiritual factors may play an equally important role in health outcomes for several medical conditions, including pulmonary disease. However, studies of this kind have not specifically examined COPD nor have they examined the role of religious and spiritual beliefs in COPD management among ethnic minority patients. As such, the current study aimed to examine whether spiritual ethnic minority patients with COPD hold religious fatalistic attitudes and less active religious problem solving . A sample of 35 ethnic minority patients from the Louis. B. Stokes Cleveland VA Medical Center (LSCVAMC) Outpatient Pulmonary Clinic in Cleveland, OH. were recruited to participate in the study. Due to the acknowledgeable limitations of the present study, results are preliminary but convey associations between religious health fatalistic beliefs and religious problem solving approaches. Implications and areas of future study are discussed. digital.library.unt.edu/ark:/67531/metadc822782/
Quantitative Eeg Analysis of Individuals with Chronic Pain
Recent advances in neuroimaging and electromagnetic measurement technology have permitted the exploration of structural and functional brain alterations associated with chronic pain. A number of cortical and subcortical brain regions have been found to be involved in the experience of chronic pain (Baliki et al., 2008; Jensen et al., 2010). Evidence suggests that living with chronic pain shapes the brain from both an architectural and a functional perspective, and that individuals living with chronic pain display altered brainwave activity even at rest. Quantitative EEG (qEEG) is a method of spectral analysis that utilizes a fast Fourier transform algorithm to convert analog EEG signals into digital signals, allowing for precise quantification and analysis of signals both at single electrode locations and across the scalp as a whole. An important advance that has been permitted by qEEG analysis is the development of lifespan normative databases against which individual qEEGs can be compared (Kaiser, 2006; Thatcher et al, 2000). Pilot data utilizing qEEG to examine brainwave patterns of individuals with chronic pain have revealed altered EEG activity at rest compared to age- and gender-matched healthy individuals (Burroughs, 2011). The current investigation extended the findings of the pilot study by utilizing qEEG to examine a larger sample of individuals with chronic pain. Individuals with chronic pain displayed significantly reduced slow wave activity in frontal, central, and temporal regions. Findings will be presented in terms of specific patterns of altered EEG activity seen in individuals with chronic pain. digital.library.unt.edu/ark:/67531/metadc822811/
Heart Rate Variability as an Indicator of Stress and Resilience in HIV+ Adults: An Analysis of a Stigma Related Stress Induction
Learning of a positive diagnosis of HIV may be one of the most challenging and stressful events in life. The memory of this event is emotionally laden, and even years later evokes an emotional response. Similarly, many people living with HIV (PLH) have memories of the first time they were treated differently because of their diagnosis. While research frequently examines the subjective of stress, few studies have examined biological markers of stress in people living with HIV. Heart Rate Variability offers a non-invasive measure of stress. Beyond serving as a biological marker for stress, changes in HRV are also associated with emotional functioning. Research demonstrates decreased HRV levels in patients with Depression, Anxiety, and PTSD. We conducted a repeated measures MANOVA to examine effects of stress induction on HRV in individuals with high and low levels of HIV-related stigma. We found that the high stigma group was significantly different from the low stigma group in regard to changes in participants’ HRV, Wilks’ λ = .50, F (1, 51) = 11.63, p < .001. A hierarchical linear regression examined the relationship between HRV and other measures of stress (Heart Rate and Blood Pressure). We found that systolic blood pressure and heart rate in the stress condition were predictive of HRV (adjusted R2=.29, F (5,46) =4.07, p<.01). Results of our study support the use of HRV as a measure of stress in HIV-positive adults. Additionally, the results of our study demonstrate significant relationships between stigma, social support and stress in HIV-positive adults. digital.library.unt.edu/ark:/67531/metadc799494/
Evaluating the Role of C-reactive Protein on Cognition and Depressive Symptoms Among Women by Mexican American Ethnicity
C-reactive protein (CRP) is a protein found in the blood that is synthesized by the liver and has been extensively studied due to its role in inflammatory and atherosclerotic processes. The importance of this biomarker in its role in vascular risk factors is increased with several lines of evidence pointing to its association with cognitive decline. The association between CRP and depression has been increasingly analyzed by various cross-sectional studies. The research between CRP and depressive symptoms in older women has yet to generate consistent trends. In the present study, a series of regression analyses was used to explore the association between CRP and both cognitive function and depressive symptomatology among a group of rural-dwelling women. Associations were evaluated through the use of data from Project FRONTIER, a rural-based research looking at both physical and cognitive aspects of health in rural-dwelling adults and elders. Comparisons were made between Mexican American women and a group of non-Hispanic Caucasian women. CRP was a significant independent predictor of total depression (beta = -.11, t = -1.99, p =.048). CRP was also a significant independent predictor of symptoms associated with meaningless within depression (beta = -.16, t = -2.94, p =.004). Contrary to prediction, CRP was not a significant independent predictor of overall cognitive function or performance in five specific cognitive domains. There is still needed evaluation on racial/ethnic differences present in regard to the impact of varied health factors on mental health within a culturally rich, rural cohort. It is recommended that future studies utilize standardized measurement of cognitive function to facilitate a more thorough understanding and comparison of change in this particular population. digital.library.unt.edu/ark:/67531/metadc700036/
Religiosity As a Coping Resource for Depression and Disease Management Among Older Diabetic Patients
Compared to the general population, diabetic patients experience a higher prevalence of depression, which can often exacerbate diabetic symptoms and complicate treatment. Studies show that religion is associated with both better physical health and better psychological functioning; however, studies incorporating religion and depression among diabetic individuals are scarce. The present study addressed this gap in the literature by examining archival data from the 2008 and 2010 data waves of the Health and Retirement Study (HRS). Cross-sectional findings confirmed that stronger religiosity was positively correlated with perceived diabetes control and positive diabetes change, and negatively correlated with total number of depressive symptoms and total number of weeks depressed. Longitudinal findings confirmed that stronger religiosity in 2008 was positively correlated with perceived diabetes change in 2010 and negatively correlated with total number of depressive symptoms in 2010. Logistic regression and multiple regression analyses were performed to test four moderation models. Results showed that religiosity significantly moderated the relationship between perceived diabetes control and total number of weeks depressed. More specifically, for diabetics with low levels of religiosity, whether they believed their diabetes was under control or not did not make a significant difference in the total number of weeks depressed. However, high levels of religiosity served as a buffer against the duration of depressive symptoms but only for diabetics who perceived to have their diabetes under control. Understanding how these constructs jointly influence diabetes management and psychological functioning is critical in that medical professionals may utilize such knowledge to enhance treatment outcomes. digital.library.unt.edu/ark:/67531/metadc700076/
Lean on Me: Social Support Compensation and Risk of Death in Older Adults with Type 2 Diabetes
Type 2 diabetes (T2DM) has an estimated incidence of nearly 11 million US adults aged 65 years and older. Evidence suggests that the quality of the marital relationship is an important factor for diabetes related health outcomes affecting self-management and adherence (Kiecolt-Glaser & Newton, 2001). However, an individual in need may compensate for primary support that is unavailable or not optimal by looking for other sources of support, which may be important for health outcomes (Rini, et al., 2008). The present study examined compensation for poor spousal support through other social relationships. A total of 12,640 participants reported they had diabetes and were married (Male = 6,317 and Female = 6,323), and of this group 1,084 men and 583 women had died over the course of the study period. Women reported lower spousal support, but significantly more aggregated social support across relationships than men. Few persons reported low spousal support and low support compensation, rendering the cell sizes highly unequal and the associated data uninterpretable. Ancillary analyses were conducted with the idea that some variance in total compensation support may moderate mortality risk finding that higher aggregated social support across non-spousal relationships was associated with lower risk of death accounting for ~3% of the variance in the final model. The current findings demonstrate how an individual can compensate for a poor primary support relationship through a broader support network. These findings should guide future research to focus on how individuals build, maintain, and seek support from social relationships. digital.library.unt.edu/ark:/67531/metadc700048/
Development of a Differential Neurocognitive Profile for Alzheimer’s Dementia and Vascular Dementia
Alzheimer’s Dementia (AD) is among the most common diseases in the Geriatric population, and its prevalence is expected to quadruple by 2047.Vascular Dementia (VaD) is the second most frequent cause of dementia, with studies indicating VaD accounts for 10-20% of dementia cases across the globe. A diagnostic model differentiating AD and VaD would be clinically and scientifically valuable, considering the treatment approaches for these conditions are different. Although there are differences between AD and VaD on their neuropsychological profiles, a diagnostic model that successfully differentiates AD and VaD on neuropsychological testing has not been developed, despite previous attempts. Our study addresses this gap in the literature by examining two diagnostic models used to predict the conversion of AD from mild cognitive impairment, and a third model was proposed to differentiate AD from VaD. We conducted ROC Analyses using the variables LM II Standard Score, Animals Total, and CDRS Sum based on a previous diagnostic model. The sensitivity and specificity for the diagnosis of mild VaD were calculated for all possible scores of each test measure. The Animals Total cutoff score of 7 achieved excellent sensitivity and specificity, receiving 96% and 92%, respectively. In this sample, patients who could name at least seven animals under 60 seconds were highly likely to be diagnosed with VaD. LM II Scaled Score also achieved statistical significance (p <0.001) and a cutoff score of 4 received 96% sensitivity and 77% specificity. Patients who achieved an LM II Scaled Score of 4 or higher were highly likely to be diagnosed with VaD. digital.library.unt.edu/ark:/67531/metadc500158/
Personality Factors and Trust in Placebo Medical Trials
Prior research has reported that individual differences influence both placebo and nocebo responses. The present study examined how individual personality, as well as trust, influence placebo/nocebo belief and symptom reporting after receiving an inert capsule that for some was described as an active “cognitively-enhancing” trial medication. Individuals (N = 104) were randomly assigned to one of three conditions: condition A participants were told they’d received the medication, condition B participants were told they’d received a placebo, and condition C participants were told, via random assignment, each would receive either the medication or placebo (after the experiment this condition listed the group – medication or placebo - each believed s/he was in). The study was completed in the UNT Student Health and Wellness Center to provide context in a medical setting. Of the 104 participants, 46 (44.2%) were either placed by experimental design or self-report in the medication group. Participants with a belief in medication ingestion, regardless of condition (i.e., A or C), reported significantly more symptoms (M = 16.65, SD = 3.178), than participants who believed they had ingested a placebo (M = 14.21, SD = 2.58), t (102) = 4.32, p = .001. Aspects of Neuroticism and Extroversion, as well as trust were correlated with symptom reporting and/or placebo/nocebo responses. It appears that that personality is part of a combination including trust, context and expectations. It is recommended that future research on personality and placebo effects consider the role of individual factors, context and communication of expectations. digital.library.unt.edu/ark:/67531/metadc500050/
Factor Analysis of the Clinical Scales on the Luria-Nebraska Neuropsychological Battery, Form II
The Luria-Nebraska Neuropsychological Battery (LNNB) was published in 1980 as an attempt to provide clinicians with a standardized version of the neuropsychological assessment and diagnostic procedures proposed by A. R. Luria and A, L. Christensen. Research on the LNNB included a series of factor analyses for each of eleven clinical scales. The analyses were completed on the combined scores obtained from a sample of normal, brain-damaged, and psychiatric populations. A second version of the LNNB was published in 1985 as a largely parallel version of Form I, but included changes in stimulus materials, administration procedures, and scoring procedures. The present study completed factor analyses on same eleven clinical scales using data generated with the newer LNNB Form II. The statistical procedures and criteria employed in the present investigation were identical to those used earlier on Form I to allow for comparisons between the two resulting sets of factor structures. The patient populations were different, however, in that all subjects in the current study were receiving inpatient care in a private psychiatric hospital which specializes in long-term treatment. Despite the changes in materials and procedures and the difference in subject parameters, the factors identified in the present investigation are similar to those seen in the Form I studies. However, two trends were observed when comparing the two sets of factor structures. First, in the present study several items were excluded from the statistical procedures because they were performed perfectly by almost everyone and the resulting scores lacked statistical variance. Second, more homogenous factors were obtained with the Form II analysis. That is, some of the complex LNNB Form I factors were reduced to two or more simpler factors. The results of the study lend support to Luna's conceptual model of higher cortical function and to the reliability of the LNNB as an assessment instrument. digital.library.unt.edu/ark:/67531/metadc332095/
Aerobic Conditioning: Effects on Locus of Control, Mood States, and General Well-Being
This study was conducted to examine the sequelae of cardiovascular conditioning on locus of control, short-term mood, and psychological well-being. A pre-post test design, with control group, was used to measure the effects of a one month program of aerobic conditioning on adult volunteers. This study also sought to examine ways in which fitness changes covaried with psychological changes, and to describe patterns of change taking place during aerobic conditioning. digital.library.unt.edu/ark:/67531/metadc332376/
Total Stress Load Inventory: A Validation Study
The purpose of this study was to validate a stress inventory which would differentiate between a normative group and a patient population suffering from environmental illness. The hypotheses of this study were: (1) the Total Stress Load Inventory would be predictive in discriminating between clinical ecology patients and a normative group; (2) each section or subscale of the Total Stress Load Inventory would be predictive of psychological, cognitive, nutritional, and/or medical factors. digital.library.unt.edu/ark:/67531/metadc330618/
A Comparison of Imagery Relaxation and an Educational Treatment Modality for Dysmenorrhea
This study is a comparison of four treatments involving education and imagery relaxation for the amelioration of dysmenorrhea. Treatment was presented to 76 subjects by videotape during a one-hour session. A six month follow-up was performed using one of the original instruments, the Symptom Severity Scale (Cox & Meyer, 1978) and a questionnaire designed for the study. Analysis of the test instruments indicated a significant treatment effect for the educational group. The second most effective treatment was a combined treatment utilizing imagery relaxation and education, although this group did not produce significant results. The no-treatment control group was more effective in diminishing symptoms than the fourth group, imagery relaxation alone. The lack of effectiveness of the imagery relaxation treatment was hypothesized to be due to lack of reinforcement of the technique. The educational treatment modality offered the individual an opportunity to learn about many different etiological facets of dysmenorrhea, including biological, learning, and cognitive factors. The presentation also introduced the individual to several different treatment modalities in order to provide an armamentarium of effective methods for diminishing or eliminating dysmenorrhea. These results suggest that there is a need for education about dysmenorrhea before menarche, in order to prepare, prevent, treat, and cope with this syndrome. digital.library.unt.edu/ark:/67531/metadc331134/
Temperature Biofeedback and Visual Imagery in the Treatment of Migraine Headaches
After an initial four week baseline period, during which headache activity and medication consumption were monitored, 28 migraineurs were randomly assigned to one of the following groups: (a) the biofeedback temperature warming group, (b) the visual imagery group, (c) the combined treatment group, or (d) the comparison group. All four groups continued to monitor their headache activity and medication consumption during the eight week treatment period and the eight week follow-up period. A two way analysis of variance computed on groups over time indicated a significant decrease in headache activity and medication consumption. During the follow-up period (a) the combined treatment group had significantly fewer headaches than the biofeedback group or the comparison group and (b) the visual imagery group and the combined treatment group had significantly fewer headache hours than the biofeedback group or the comparison group. These results do not appear to be attributable to differences between groups on the amount of time spent in home practice or subjective ratings of relaxation. There was no consistent relationship between increases in finger temperature and headache activity improvement. Decreases in powerful other scores, as measured by the Health Attribution Test, and increases in subjective ratings of internal control were consistent with a reduction in headache activity and medication consumption. digital.library.unt.edu/ark:/67531/metadc331412/
Cognitive Coping Strategies with Chronic Back Pain Patients
Low back pain has long been estimated to be the most prevalent and debilitating source of chronic pain. The present study first reviews the literature addressing the various theories of pain, the physiological and psychological variables important in pain research, and the psychotherapeutic approaches that have been used to date to reduce pain. Thirty-seven hospitalized chronic back pain patients were administered the cold-pressor test and a medical pain stimulus procedure which was medically relevant to their back pathology. A card-sort method was utilized in order to assess the coping strategies employed by the patients during these two pain stimulus tasks. These procedures were repeated following treatment. Coping strategies used by patients during the two pain tasks were compared. Results demonstrated that there was a significant difference in the manner in which patients coped with the two types of pain. Cold-pressor measures of pain threshold and tolerance were not significantly different between pretreatment and post-treatment. These measures were also not positively correlated with treatment outcome. A multiple regression approach demonstrated that particular coping strategies were significantly predictive of treatment outcome. The medical pain stimulus procedure was found to provide more significant pedictor variables than the cold-pressor test. At pre-treatment assessment, patients who relied on dramatized coping strategies were less likely to be successful in treatment. Breathing activity and pain acknowledgement were positive coping techniques highly predictive of successful outcome in this study. The use of computers for assessment and other recommendations for future research were discussed. digital.library.unt.edu/ark:/67531/metadc331556/
A Measure of Dependency in Patients with Chronic Illness: Clinical Ecology
This study briefly reviews both historical and recent conceptualizations of dependency. In particular, it focuses on this concept's applicability to patients with chronic illnesses, especially those with allergies. Type and degree of dependency were seen as an important factor in the approach to the medical and psychological treatment of clinical ecology patients. The purpose of the study was to develop an objective measure of dependency which could quickly identify patients whose dependency conflicts interfere with the treatment process. The study was divided into three phases. In the first phase test responses by 84 inpatients to the CAQ, MMPI, and the HAT as well as historical and demographic data were analyzed by a series of stepwise discriminant analysis. The 53 resulting items were examined for those which most concisely discriminated between the two identified groups (pathologically dependent and nonpathologically dependent). These 15 items were used to test 120 additional patients in phase II. Fourteen items were retained and the coefficients obtained classified the patients in phase I and II with a 98.81 percent and 94.17 percent degree of accuracy respectively. These classification coefficients were used to classify another 30 patients in phase III with a 96.67 percent rate of accuracy. These results provide exceptionally strong support for the hypothesis that group classification can be obtained through the use of an objective screening instrument. The pathologically dependent patients tend to focus on disease, frequently are unemployed, have histories of childhood illnesses, have limited emotional controls, are depressed, ambivalent, and distrustful. Additionally, they experience difficulty establishing goals or accepting personal responsibility. Those patients identified as nonpathologically dependent exemplify the more positive aspects of these traits. The pathologically dependent patients appear to be caught in a dilemma between wellness and satisfaction of dependency needs. While all patients need an organized approach to treatment, the pathologically dependent require an extremely structured repititious approach and may require long term psychological intervention in order to make positive steps toward wellness. digital.library.unt.edu/ark:/67531/metadc331630/
Glucose As an Energy Source to Increase Self-control in Restrained Eaters
Research evidence is suggestive of a strength model of self-control, also known as ego depletion, in social psychological literature. Engaging in an initial task of self-control depletes a limited resource, resulting in less self-control on a subsequent, unrelated task. The strength model of self-control has been applied to many practical, everyday situations, such as eating behaviors among dieters. Newer studies suggest that blood glucose is the resource consumed during acts of self-control. Consuming glucose seems to "replete" individuals who have been depleted, improving performance and self-control. The current study aimed to examine the effects of ego-depletion on restrained eaters. The hypothesis was that restrained eaters who were depleted by a task of self-control would exhibit more disinhibition on a taste-test task than would restrained eaters who were not depleted. However, if the participants were given glucose following the depletion task, then their self-control would be "repleted" and they would exhibit similar control to that of the non-depleted participants. Contrary to expectations there were no differences between the groups in terms of total amount of cookies consumed. These results are inconsistent with a glucose model of self-control. Suggestions for future research and implications of the findings are discussed. digital.library.unt.edu/ark:/67531/metadc283842/
Does Unemployment Become a Major Stressor in the Evolution of Chronic Pain?
Pain has been described as the most complex human experience and most frequent reason patients seek medical treatment. Few people fail to experience the pain associated with disease, injury, or medical/surgical procedures. However, the impact of unemployment that results from chronic pain suffering has not been widely researched. To present a comprehensive view of the effect unemployment has upon the chronic pain experience, this study focused upon stress philosophy, chronic pain, employment, and coping effectiveness. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and a Personal Data Questionnaire (PDQ) were administered to 96 persons (four groups of 24 subjects) representing either unemployed or employed and either chronic or non-chronic (acute) pain populations. digital.library.unt.edu/ark:/67531/metadc278597/
Predictors of Hiv-related Neurocognitive Impairment in an Hiv/aids Population
Although, in the United States HIV infectivity has increased, survival rates have also improved due to highly active antiretroviral therapies (HAART). Adherence to HAART successfully prevents the progression of AIDS and AIDS-related morbidity for many living with HIV. Unfortunately, HAART’s permeability into the central nervous system (CNS) is limited; thus, the prevalence of HIV-associated neurocognitive disorders (HAND) still persists. The health belief model (HBM) is the theory often used to explain and predict behavior in relation to chronic illness. This model incorporates perceptions of susceptibility, vulnerability, and severity towards a particular illness, and beliefs regarding perceived efficacy and benefits of treatment. This study expands the existing model. Many who live with HIV have a long history of negative experiences, such as stigmatization, traumatic events, and discrimination. I examined supplementary psychosocial and physiological predictor variables, such as stigma, trauma, ethnicity, general medical conditions, HIV-opportunistic infections, and falls; all relevant to disease progression in HIV. Previous researchers found links between stigma and immune function, trauma and memory, ethnicity and neuropsychological impairment, and symptom load and CNS-related alterations. Therefore, this study examined how these different psychosocial predictor variables are associated with HIV-related neurocognitive impairment. My model explained 38.6% of the variance in the outcome variable, and I found that trauma (B = -.15, OR = .87; CI 95% = .75, 1.0, p = .05), ethnicity (B = 2.2, OR = 9.0, CI 95% = 1.68, 48.48, p =.01), general medical conditions (B = .30, OR = 1.34; CI 95% = 1.0, 1.81, p = .05), and falls (B = 2.0, OR = 7.2; CI 95% = 1.1, 47.0, p = .04), were all significant predictors of HIV-related neurocognitive impairment. However, contrary to my hypothesis, HIV-related opportunistic infections and HIV-related stigma were not significant predictors of HIV-related neurocognitive impairment. I hope that my results will contribute to revisions of older health models as well as suggest avenues for primary and secondary prevention and intervention to address those living with HIV/AIDS. digital.library.unt.edu/ark:/67531/metadc149667/
Female Orgasm From Intercourse: Importance, Partner Characteristics, and Health
Previous research indicates that women prefer orgasms triggered by penile-vaginal intercourse (PVI) as compared to those triggered by direct manual stimulation of the clitoris. However, for reasons that are not well understood, most women are unable to reach PVI orgasms as often as they desire. In addition, it is unclear why many women prefer PVI orgasms to those triggered by direct clitoral stimulation. This study developed a more precise measure of PVI orgasm frequency and evaluated key predictors of this frequency, including duration of intercourse, physical and psychological health, and partner traits with implications for either mating quality or relationship quality. The present study also measured PVI orgasm importance and investigated why it is important for many women. The sample consisted of 835 adult women with experience in PVI. Mean PVI orgasm frequency was 50%, with 39.4% of women never or rarely having PVI orgasms, 37.1% sometimes having PVI orgasms, and 23.5% almost always or always having PVI orgasms. As a median response, women believed that PVI orgasm was “very important” and perceived importance was correlated with orgasm frequency (r = .31, p < .001), as were reasons for importance. Duration of intercourse showed a linear relationship with PVI orgasm frequency, but this finding was qualified for women at the low and high extremes of the orgasm frequency distribution. Body esteem, anxiety during intercourse, exercise, and general pain predicted PVI orgasm frequency. Sensitive male traits, although valued by women even more highly than alpha male traits, showed notably weaker relationships with PVI orgasm than did male alpha traits. This is consistent with evolutionary theories of orgasm, and it supports the view that the female orgasm may function to favor some males over others in terms of sire choice. Clinical and theoretical implications of the present findings are discussed. digital.library.unt.edu/ark:/67531/metadc149654/
A Randomized Clinical trial of Cognitive-Behavioral Therapy for Insomnia in a College Student Population
Nearly 10% of college students experience chronic insomnia. Cognitive-behavioral therapy for insomnia (CBTi) is an empirically validated multi-component treatment that has been demonstrated to produce reliable and durable benefits in the general adult population. However, there have been no studies examining the effectiveness of multi-component CBTi in a college student population, even though many studies have examined the efficacy of single treatment modalities. These young adults are different from the general adult population because they are in a unique transitional developmental phase as they are maturing from adolescence into adulthood, they are sleepier than adults, they tend to have irregular sleep schedules, and their living situations are often different from the general adult population. In this study college students with chronic insomnia were randomly assigned to either six sessions of CBTi or a wait list control (WLC) group. All participants completed sleep diaries, sleep measures, and psychosocial measures. The results indicated students who received CBTi showed improvements in sleep efficiency (SE), sleep onset latency (SOL), number of awakenings (NWAK), time awake after sleep onset (WASO), and sleep quality (SQ). They also had decreased insomnia severity (ISI), dysfunctional beliefs about sleep (DBAS), and general fatigue (MFI), as well as increases in global sleep quality (PSQI). digital.library.unt.edu/ark:/67531/metadc84307/
Type D Personality and Coping Style as Predictors of Cardiovascular Risk
Although cardiovascular disease (CVD) does not occur until mid to late life for most adults, the presence of risk factors for CVD, such as high blood pressure (BP) and high cholesterol, has increased dramatically in young adults. Type D personality consists of two personality traits, negative affectivity (NA) and social inhibition (SI), and has repeatedly been shown to be an independent predictor of hard medical outcomes (e.g. morbidity and mortality) in cardiac patients. The present study examined the relationships between Type D personality (high NA and high SI), coping strategies, and physiological markers of cardiovascular health in a sample of non-medical, university students. Measures of cardiovascular risk included high frequency heart rate variability (HF HRV), calculated LDL cholesterol, and systolic blood pressure (SBP). Regression analyses revealed that higher use of social supportive coping was a significant predictor of calculated LDL cholesterol. Social supportive coping was also shown to moderate the relationship between Type D personality and HF HRV. Interventions that target psychological and physiological mechanisms associated with CVD are well developed. Clear identification of young adults who are at risk of developing CVD is necessary to intervene in a manner that could potentially save lives. Additional systematic research, especially if it is longitudinal, will help to clarify the ability of Type D personality and coping to predict CVD. digital.library.unt.edu/ark:/67531/metadc84244/
Pediatric Feeding Disorders: A Controlled Comparison of Multidisciplinary Inpatient and Outpatient Treatment of Gastrostomy Tube Dependent Children
The efficacy of multidisciplinary inpatient and outpatient treatment for transitioning children with severe pediatric feeding disorders from gastrostomy tube dependency to oral nutrition was investigated utilizing caloric and fluid intakes as an outcome measure. The study involved 29 children ages 12 months to 5 years of age with gastrostomy tube dependency. Treatments were provided by speech therapists, occupational therapist, dietician and psychologist for a 30 day period. Four treatment groups were evaluated and average intakes compared at 4 observation periods including pretreatment, initiation of treatment, completion of treatment at 30 days and 4 month follow-up. Children receiving inpatient treatment for feeding disorders evidenced significant differences in oral caloric intake from pretreatment to discharge than outpatient treatment (p < .01) and wait list control group (p = .04). Oral caloric intake from discharge to 4 month follow up yielded no significant differences indicating treatment gains were maintained. Change in environment and caretaker showed a significant effect for the inpatient group (d = 1.89). Effects of treatment by age and weight at 4 month follow up were also analyzed. digital.library.unt.edu/ark:/67531/metadc33140/
Anxiety, Depression, and Sleep Disorders: Their Relationship and Reduction with Neurotherapy
This study investigated the relationship among anxiety, depression, and sleep disturbances and the treatment of these three disorders through neurotherapy. Research suggests that these conditions commonly co-occur in the general population and that central nervous system (CNS) arousal may play a primary role in the development and maintenance of these disorders. Several recent studies suggested that neurotherapy, a biofeedback-based treatment for CNS dysregulation, might be an effective treatment for comorbid conditions, particularly the ones of interest here, depression, anxiety, and sleep disturbances. This investigation used a clinical case-series design to assess pre/post neurotherapy changes on objective measures of anxiety, depression, and sleep and to determine whether changes in anxiety and depression then predict improvements in sleep quality. Data for 23 participants (10 males) were obtained from files of adults (Mage = 40.22 years, SD = 16.20) who received at least 15 neurotherapy sessions (M = 47.83 sessions, SD = 22.23) the University of North Texas Neurotherapy Lab. Matched pair t-tests revealed that symptoms of sleep disturbance, depression, and anxiety showed significant improvements following neurotherapy. Neurotherapy treatment effect sizes generally ranged from moderate to large (d = .414 - .849). Multiple regression analysis found that changes in self-reported anxiety symptoms, but not depressive symptoms, predicted observed improvements in sleep quality (adjusted R2 = .26). Last, the implications and limitations were discussed in relation to neurotherapy practice and the associated research. digital.library.unt.edu/ark:/67531/metadc31533/
Natural Course of Adolescent Insomnia: Patterns and Consequences
Approximately 2-11% of adolescents report chronic insomnia. The study used an archival data set from ADDHealth that assessed adolescent health and health-related behaviors. Adolescents (N = 4102) provided data at baseline (Time 1) and at 1-year follow-up (Time 2). Participants were excluded if no ethnicity, gender, or insomnia data were given at Time 1 or 2. Females were more likely to report insomnia than males at Times 1 and 2. In addition, adolescents with remitted insomnia were significantly younger than adolescents without insomnia at Times 1 and 2. Analyses found a prevalence of 9.6%, a remittance of 6.2%, an incidence of 4.4%, and a chronicity of 2.9%. At Time 1 and 2, AWI were significantly more likely to have depression, suicidal behaviors, and behavioral problems in school than AWOI. At Time 2, incidence and chronic insomnia increased the risk of depression, suicidal behaviors and behavioral problems in school. Risk and protective factors analyses indicated psychological counseling was associated with both remitted and chronic insomnia and depression was associated with incidence insomnia. digital.library.unt.edu/ark:/67531/metadc30506/
The Effects of Positive Emotion, Negative Emotion, Flourishing, and Languishing on Cardiovascular Risk
Positive psychology has led a movement that concentrates on positive characteristics. The current study examined the relationship between positive emotions, negative emotions, flourishing, languishing, and cardiovascular functioning. The study uses guided imagery to help participants recall a negative emotional event and positive emotional event in a counterbalanced order. The reverse order allowed us to examine the differential contributions of stress buffering versus facilitated recovery effects to higher levels of heart rate variability (HRV). The study also examined the relationship between mental health categories and known cardiovascular disease risk. Univariate analysis of variance revealed that positive emotions can serve as a stress buffer and dampen cardiovascular responses to a negative event. Also, analysis revealed a trend for the prediction that positive emotions can facilitate cardiovascular recovery following a negative event. Exploratory analysis did not reveal differences between a facilitated recovery group and a buffering group for cardiovascular measures. Future studies should include tighter control to help compare the differential influences of stress facilitation and stress buffering on cardiovascular functioning. The results from the study indicate that it is still too early to tell whether mental health buffers those individuals from developing CVD, and to answer whether languishing increases the risk of CVD. Longitudinal studies of young individuals without a prior history of any risk of CVD and who are flourishing or languishing might help provide answers to these questions. digital.library.unt.edu/ark:/67531/metadc30503/
The Effect of a Brief Acceptance-Based Protocol on Health Related Relational Framing
Behavior analysts who study verbal behavior theorize that people derive relationships between stimuli - forming stimulus classes such that psychological functions transfer among stimuli and therefore affect behavior. Verbal processes are thought to play a role in cancer patients' behavioral flexibility. The current study examined if an analogue intervention produced changes in relations between health-relevant stimuli from pre- to post-test in patient and student samples. A matching-to-sample (MTS) task required participants to form three 4-member classes that included health, treatment, or neutral terms. Participants next listened to either an acceptance-based or a control-based rationale and therapy exercise, or a distracter task. Then, they were re-exposed to the MTS task. Latencies and accuracies for learning each class as well as between condition differences were examined. Finally, changes in ratings of stimuli from pre to post analogues were measured. Differences in stimuli ratings were seen in the student sample, reflecting transfer of function and some reduction in responsiveness to stimuli following intervention, but overall no learning performances are found. Discussion explores the consistency of the findings with acceptance and commitment therapy (ACT) theory in light of the seemingly lack of findings. digital.library.unt.edu/ark:/67531/metadc30488/
The Relationship Between Sleep Variables and Headache
Headache pain impacts most of the population at some point in life, at an enormous cost to day-to-day functioning. Determination of the variables that are associated with prevalence and severity of headaches has been inconsistent. One area that deserves more attention is the relationship between headaches and sleep. For instance, several sleep parameters may precipitate or exacerbate headaches, but previous research often used inconsistent and limited assessments of both headaches and sleep, making results difficult to interpret and compare. The current study seeks to extend previous research by using more comprehensive and empirically validated assessment techniques to study the relationship between sleep and headaches in a healthy sample. Greater self-reported sleep quality is related to lower headache frequency and severity, and lower self-reported sleep quality is characteristic of individuals having migraine-type headaches. Greater sleep efficiency is related to lower headache severity and shorter headache duration. Greater sleep onset latency is related to longer headache duration and greater headache severity. Greater number of nighttime awakenings is related to greater headache severity and is characteristic of individuals having a diagnosable headache disorder (either tension-type or migraine-type). Stress appeared to be a partial mediator between self-reported sleep quality and headache severity. Further experimental studies may clarify causality between sleep and headache. digital.library.unt.edu/ark:/67531/metadc30460/
QEEG and LORETA findings in children with histories of relational trauma.
Abuse and neglect occurring in childhood have been associated with a number of functional and physiological effects on the brain. This study extends previous research that investigated the quantitative electroencephalogram (qEEG) patterns in children with histories of relational trauma through the inclusion of additional participants and measures. As in previous studies, the relative power, absolute power, and coherence values in children with histories of abuse were compared to the Neuroguide database. Results did not show any significant differences in relative or absolute power in the theta range. Similarly, there were no significant coherence differences. Database comparisons were also made using low resolution electromagnetic tomography (LORETA) in order to determine which sub-cortical brain structures may be affected by abuse or trauma, though there were no significant differences in any frequency (0-30Hz). A review of the literature suggests that the prevalence of mu in normal adults and children ranges from 0 to 19%. The present study found a mu prevalence rate of 60.6% in the children who experienced abuse or neglect. Finally, comparisons were made between participants who demonstrate a mu pattern and those who do not to determine if this pattern is associated with certain behavioral and/or attention problems as assessed by the Child Behavior Checklist (CBCL) and the Tests of Variables of Attention (TOVA), respectively. There were no significant differences between children with a mu pattern versus children who did not exhibit a mu pattern on the Social Problems, Thought Problems, or Attention subscale scores on the CBCL or on the Commission subscale score on the TOVA. digital.library.unt.edu/ark:/67531/metadc28394/
Psychological Stress Reactivity and Recovery: The Role of Cognitive Appraisals, Ethnicity and Sex
The aim of this research was to investigate the role of sex, ethnicity and cognitive appraisals, separately and in combination, on the physiological stress response. One hundred and eight undergraduate students from two North Texas universities participated in the study. They were subjected to a laboratory stressor and heart rate, peripheral temperature and cortisol levels were measured pre-, during-, and post- stressor. Perceived stress and cognitive appraisals were measured via self-report. Multivariate analysis of variance tests were conducted to analyze the main and interaction effects during baseline, reactivity and post-stress recovery. Results indicated some significant main effects for sex and ethnicity but no consistent pattern of results or interactions among variables were revealed. The study's implications and areas of future research are discussed. digital.library.unt.edu/ark:/67531/metadc12158/
Evaluation of skill maintenance, performance factors, and external validity in a behavioral parent training program.
Child maltreatment affects 900 thousand children in the U.S. every year and impacts all areas of daily functioning. Behavioral parent training (BPT) programs have effectively taught parenting and demonstrated externally valid outcomes (i.e., lower recidivism rates). Skill maintenance assessments for BPTs have mixed results. The Behavior Management and Parenting Services (BMAPS) program has shown effective skill training for court-mandated families. This study assessed skill maintenance and performance factors that may have impaired parents using an ABAB single-case research design in Phase 1 & external validity with a survey in Phase 2. Results for Phase 1 found that most BMAPS parents acquired all parenting tools to criteria, dropped below criteria at the 3 month probe, then fully demonstrated their regained skills after a brief review. Psychological and classroom factors do not appear to have systematically influenced performance at any time, although homework completion was associated with better scores at the end of class. Phase 2 results found a 91% reunification rate and a 0% recidivism rate over 1-3 years. All limitations aside, it appears that the BMAPS program is able to effectively train skills to criteria and these skills can be sustained with a booster session. The vast majority of parents we contacted were reunified with their children and none were involved with additional charges of child maltreatment. digital.library.unt.edu/ark:/67531/metadc12197/
The relationship between racial discrimination induced anger and smoking among Black adolescents.
This study explored whether a relationship exists between smoking behaviors and racial discrimination induced anger among Black adolescents. Participants consisted of 134 Black adolescents from 14 to 18 years of age who frequently visited a recreation center in the Northeast. Forty-four participants were males and 90 were females. All participants were administered a modified version of the CAGE questionnaire, a background information questionnaire, and a measure designed to assess the extent to which they feel angry because they had been discriminated against. Only age was found to be predictive of scores on the CAGE. Only gender was found to be predictive of smoking frequency. The Black Anger Measure (BAM) was significantly correlated with smoking behaviors. Some implications for theory, research and practice are suggested. digital.library.unt.edu/ark:/67531/metadc11022/
Cognitive Dysfunction in Middle-Aged Adults vs. Older Adults with Obstructive Sleep Apnea
The presence of cognitive deficits in obstructive sleep apnea (OSA) is well-documented. Specifically, short- and long-term memory, attention/vigilance, and executive function (e.g. processing speed, mental flexibility, and problem solving) are affected. Cognitive deficits in aging occur in similar areas (i.e., memory and processing speed). Given that a greater percentage of older adults experience sleep-disordered breathing as compared to middle-aged adults, it is possible that OSA may account for some of the deficits typically attributed to aging. This study investigated this hypothesis by comparing middle-aged and older adults with and without OSA on computer-based measures of cognitive performance. No effect of OSA or an interaction between OSA and age on cognitive function was found; an effect of age on processing speed, distinguishing stimuli rapidly, attention, spatial ability/mental flexibility, and both working memory and short-term visual memory was found. This study also explored whether or not cognitive function may be improved in persons with OSA by re-assessing those participants one month after treatment. An effect of treatment on improvements on processing speed, distinguishing stimuli rapidly, mental flexibility, and short term memory was found. Overall, findings reflect the ability of treatment to improve cognitive function among OSA patients, regardless of lack of deficits when compared to those without OSA. digital.library.unt.edu/ark:/67531/metadc11049/
Role of Parental Anxiety on Pediatric Feeding Disorders
The proposed study examined the relationship between parental anxiety, measured both subjectively (via self-report questionnaires) and objectively (via salivary cortisol) and the child's feeding progress. Children diagnosed with a feeding disorder were recruited with their parents at Our Children's House at Baylor (n=19; 11 females, 8 males). The patients and their parents were housed in the clinic for an eight-week intensive multidisciplinary pediatric feeding disorder treatment program. Calorie intake was recorded daily as outcome measures of treatment progression. Parental anxiety was measured by the Pediatric Inventory for Parents (PIP), state anxiety on the State Trait Anxiety Inventory (STAI), and by salivary cortisol at three different time points. The present study attempted to examine whether parental feeding (phase three of treatment program) would continue to cause a decrease in the child's caloric intake. In averaging ten meals prior to parental feeding in comparison to the average of ten meals following parental feeding, there was no significant difference as measured by a t-test. Paired t-tests examined parental anxiety from time one to time two and found that salivary cortisol increased significantly t(15) = -6.07, p = .000 from Time 1 (M = 2.30, SD = 1.64) to Time 2 (M = 5.24, SD = 2.58). This demonstrated that while parental anxiety increased as measured by salivary cortisol, the children continued to make improvements. This may be the result of the multidisciplinary feeding program which encompassed a strong behavioral component and parent training. Even though the current results did not demonstrate a direct relationship between parental stress and caloric intake, parental stress as measured by salivary cortisol did increase. digital.library.unt.edu/ark:/67531/metadc9853/
Neurocognitive implications of diabetes on dementia as measured by an extensive neuropsychological battery.
Diabetes is a disease with a deleterious pathology that currently impacts 4.5 million individuals within the United States. This study examined the ability of a specific neuropsychological battery to identify and classify dementia type, investigated the impact of diabetes on cognition and analyzed the ability of the memory measures of the 7 Minute Screen (7MS) and the Rey-Osterrieth Recall to correctly categorize dementia type when not used in combination with a full battery. The battery in addition to exhaustive patient history, medical chart review and pertinent tests were used in initial diagnosis. Results indicated the battery was sufficient in the identification and classification of dementia type. Within the sample, diabetes did not appear to significantly impact overall battery results whereby only two measures were minimally affected by diabetes. Finally, the memory measures of the 7MS and the Rey-Osterrieth Recall were sufficient to predict membership into the Alzheimer's (AD) and vascular dementia (VD) groups with 86.4% accuracy. The classification percentage dropped to 68.3% with addition of the mild cognitive impairment category. The full battery correctly classified AD and VD dementia 87.5% and appeared to be the most robust. digital.library.unt.edu/ark:/67531/metadc9774/
An item response theory analysis of the Rey Osterrieth Complex Figure Task.
The Rey-Osterrieth Complex Figure Task (ROCFT) has been a standard in neuropsychological assessment for six decades. Many researchers have contributed administration procedures, additional scoring systems and normative data to improve its utility. Despite the abundance of research, the original 36-point scoring system still reigns among clinicians despite documented problems with ceiling and floor effects and poor discrimination between levels of impairment. This study is an attempt to provide a new method based upon item response theory that will allow clinicians to better describe the impairment levels of their patients. Through estimation of item characteristic curves, underlying traits can be estimated while taking into account varying levels of difficulty and discrimination within the set of individual items. The ultimate goal of the current research is identification of a subset of ROCFT items that can be examined in addition to total scores to provide an extra level of information for clinicians, particularly when they are faced with a need to discriminate severely and mildly impaired patients. digital.library.unt.edu/ark:/67531/metadc9783/
Neurocognitive Variables Underlying Group Performance on a Measure of Effort: The Medical Symptom Validity Test (MSVT)
This study utilized the Medical Symptom Validity Test (MSVT) and a set of standard neuropsychological instruments to determine the underlying construct of the MSVT that accounts for effort in mild traumatic brain injury (mTBI) patients by comparing/contrasting mTBI with dementia and an analog simulation. The results indicate that a common underlying neurocognitive construct (memory) exists between mTBI and dementia patients, which may account for poor effort as measured by the MSVT. Other underlying factors emerged for both groups, though they did not point to a common construct. This finding suggests that the overall effect of brain injury in neurologically impaired groups also impacts effort performance as measured by the MSVT. Similarly impaired performance patterns also emerged between mTBI and dementia groups in sub-groups that failed effort measures. Thus, failed effort tests may be a function of more pronounced deficits in these groups, rather than a function of effort. Finally, although similar effort profiles were noted between mTBI and analog simulators, the analog group was unable to mimic the neurocognitive effects of mTBI. digital.library.unt.edu/ark:/67531/metadc9787/
Association Between Folate, Vitamin B12 and Cognitive Performance in Demented Elderly.
Dementia is prevalent among elderly people. As the world population ages, it is projected that the number of people affected by dementia may triple in the next 50 years. Over the last two decades, research has focused on identifying potentially modifiable risk factors in development and progression of dementia, such as vitamin B12 and folate. Results concerning the effects of low folate and vitamin B12 on cognitive performance are mixed. The main objective of the present study was to investigate the effects of vitamin deficiency on cognitive functioning in a clinical sample of elderly individuals with cognitive problems using a comprehensive neuropsychological assessment. A retrospective chart-review was performed on the 102 records of patients from the Geriatrics Clinic at the University of North Texas Health Science Center who presented with cognitive deficits. Charts were reviewed to obtain data on vitamin supplementation, vitamin status, history of chronic conditions and other biochemical data. The available database was used to obtain data on neuropsychological assessment. The study demonstrated mild association between vitamin B12 and folate status and cognitive deficits. There appeared to be a higher cut-off level that is above the traditionally used levels for vitamin B12 and folate deficiency concentrations at which cognitive deficits became more pronounced. Clinical applications, limitations and suggestions for future research were discussed. digital.library.unt.edu/ark:/67531/metadc9034/
Heart rhythm variability in persons with chronic pain.
The present study evaluated the utility of heart rhythm coherence (HRC) feedback to reduce the reported pain intensity of patients enrolled in a multimodal pain management program. Participants were recruited and assigned to a usual treatment group (UT) or a heart rhythm coherence feedback group (UT+HRC). It was hypothesized that UT+HRC participants who achieved heart rhythm coherence would report a reduction of pain intensity, as measured by the McGill Pain Inventory. For those whose pain intensity decreased, it was also expected that their self reported levels of depression as measured by the Beck Depression Inventory-Second Edition and state anger as measured by the State Trait Anger Inventory would decrease. It is also hypothesized that with a reduction in pain levels, anger, and depression, blood pressure would also decrease among those who had high blood pressure prior to the intervention. Multivariate analyses of variance (MANOVA) were used to investigate the relationship between treatment condition, coherence status and pain levels. A series of independent t-tests were utilized to investigate the change in pain, depression, and state anger from baseline to posttest, followed by Pearson product moment correlation coefficients on difference scores to understand the relationship between the outcome variables for Hypothesis 2. Standard multiple regression analyses were computed using difference scores to determine if the outcome measures were significant predictors of systolic blood pressure and diastolic blood pressure. Results indicated a failure to reject the null with regard to hypothesis one. No relationship between treatment assignment, coherence status or pain levels were found. Hypothesis 2 was partially supported. Although there was a positive significant relationship between depression and anger when utilizing difference scores, these affective measures were not related to difference scores on either pain measure. In regard to Hypothesis 3, there was also a failure to reject the null. None of the outcome measures utilized in this study emerged as being significantly related to changes in systolic or diastolic blood pressure. Limitations of the study and implications for future research are offered. digital.library.unt.edu/ark:/67531/metadc9037/
Evaluation of the Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR) in a spinal cord injury population.
Spinal cord injury (SCI) is an acute and devastating event that results in significant and permanent life changes for the individuals who are injured, as well as their families and friends. Depression has received more attention from clinicians and researchers than any other psychological issue among persons with SCI. Measurement of depression in this population has a variety of methodological issues, including inconsistent assessments used (self-report versus clinical interviews), varying definitions of depression, inclusion and exclusion of physical symptoms in the assessment process, and use of measures that do not represent DSM-IV criteria for major depressive disorder. The primary goal of this study was to evaluate the Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR) and provide descriptive analyses of this measure with persons with SCI. Results showed that somatic symptoms were more frequently endorsed than psychological symptoms in this population. Additionally, scores on the QIDS-SR were significantly associated with a depression diagnosis in the patient's medical chart. However, QIDS-SR scores were not found to be correlated inversely with quality of life scores as predicted. The QIDS-SR was shown to have good internal consistency and convergent validity with patients with SCI. However, it failed to demonstrate construct validity. The QIDS-SR has the potential to be a valid measure with this population and further analysis of the psychometric properties with patients with SCI is warranted. digital.library.unt.edu/ark:/67531/metadc9045/
Health message framing : motivating cardiovascular risk factor screening in young adults.
As the leading cause of death in the United States, coronary heart disease (CHD) is a growing public health problem, despite the fact that many risk factors for the disease are preventable, especially if addressed early in life. The purpose of the current study was to examine the effects of loss-framed versus gain-framed versus information-only health messages on both intention to attend and actual attendance at an appointment to get screened for CHD risk factors (i.e., hypertension, diabetes, and dyslipidemia). It was hypothesized that a population of young adults would be more likely to view screening for CHD risk factors as a low-risk, health-affirming behavior as opposed to a risky, illness-detecting behavior and would thus be more strongly influenced by gain-framed messages than loss-framed messages. Additional goals included the exploration of the extensively researched individual health beliefs of perceived threat (as defined by the health belief model) and health locus of control as they relate to message frames. One hundred forty-three undergraduate students were randomly assigned to either the loss-framed, gain-framed, or information-only control conditions. Framing manipulation checks revealed that participants failed to discern differences in the tone and emphasis of the experimental pamphlets. As a result, no tests of framing effects could be conducted. Sixteen (11.2%) of the 143 participants who participated in Part 1 of the experiment participated in Part 2 (i.e., attended a risk factor screening appointment). Multiple regression analysis revealed risk index, age, and powerful others health locus of control as significant predictors of screening intention. Gender was the only demographic or health related variable that was significantly related to screening outcome, such that women were more likely to get screened than men. Limitations and recommendations are discussed. digital.library.unt.edu/ark:/67531/metadc9066/
Efficacy of neurofeedback for children with histories of abuse and neglect: Pilot study and meta-analytic comparison to other treatments.
This two-part study investigates the effectiveness of neurofeedback training for reducing behavioral problems commonly observed in abused/neglected children, and compares its efficacy to other treatment interventions with this population. Neuro-developmental sequelae of early relationship trauma are explored as an etiological framework for understanding disturbed affect-regulation, which appears central to the behavioral and emotional difficulties commonly experienced by this pediatric population. It is suggested that neurofeedback teaches children to self-regulate brain rhythmicity mechanisms, which in turn affects global improvements in behavior and mood. The pilot study utilizes records of 20 children removed from their biological homes by Child Protective Services. Children were assessed prior to treatment using the Child Behavior Checklist (CBCL) and the Test of Variables of Attention (TOVA), and again after 30 sessions of individualized, qEEG-guided neurofeedback training. A t-test analysis of pre- and post-scores was computed, and indicated significant improvements following treatment. A meta-analysis of existing literature on treatment interventions with abused/neglected children provides individual and aggregate effect sizes for 33 outcome studies with this clinical population, and contextualizes the results of the present pilot study within other empirically validated treatment modalities. Establishment of an overall effect size for treatment for this pediatric population provides a needed method of comparing research results across studies when control groups may not be ethical or feasible. digital.library.unt.edu/ark:/67531/metadc9085/
Psychological characteristics contributing to performance on neuropsychological tests and effort testing.
The issue of effortful patient performance has been an area of clinical interest in individuals with minor traumatic brain injury (mTBI). Clinical attention to this area has increased largely because of an increase in the number of worker's compensation claims, injury-related lawsuits and/or insanity defense pleas. As patients are presented with the opportunity for secondary gain, the issue of optimum performance on neuropsychological measures becomes salient. In addition to neurocognitive deficits, there are psychological characteristics associated with mTBI including depression, emotional disturbance, personality changes, and other psychopathology. This study utilized the MSVT, a set of standard neuropsychological instruments, and the Minnesota Multiphasic Inventory-2 (MMPI-2) to investigate the relationships between effort, psychological characteristics, and neuropsychological functioning in individuals with minor traumatic brain injuries. The first objective of this study was to determine which psychological factors were related to effort in mTBI. The second objective was to determine if there were differences between groups that performed poorly on effort testing and groups that performed adequately on effort testing, based on relevant psychological characteristics. The results of the analyses supported the first hypothesis. Hysteria was inversely related to effort, and Mania was positively related to effort on one of five measures of effort. The second hypothesis was not supported. digital.library.unt.edu/ark:/67531/metadc9093/
Individual attachment styles and the correspondence/compensation hypotheses in relation to depression and depressive experiences.
Two hundred twenty individuals participated in the present study from a university population. The study examined the relationship among attachment styles to caregivers, relationship with God, depressive symptomology, and depressive experiences. Attachment theorists have suggested a connection between childhood attachment to caregivers and current attachment to God through the idea that individuals have "working models" that form how they interpret present relationships. For the most part, the results of the current study supported the idea of correspondence between attachment to caregiver and attachment to God. Individual attachment styles to caregivers matched their attachment style to God. However, when caregiver religiousness was included as a moderating variable, results supported the theory of combined compensation-correspondence for those with insecure attachments to caregivers. Individuals with insecure attachment to caregivers were more likely to compensate for their insecure attachment bonds through participation in religious activity, whereas their internal, private relationship with God corresponded with their previous insecure attachment bonds. Individuals with insecure attachment to caregivers were more likely to endorse symptoms of depression and report introjective, but not anaclitic, depressive experiences. With respect to attachment to God, introjective depressive experiences were positively related to both anxious and avoidant attachments, whereas, anaclitic depressive experiences were positively related only to anxious attachment to God. Anxious attachment to God was found to partially mediate the relationship between insecure attachment to caregivers and depression symptoms. Finally, attachment effects were similar across gender, ethnicity, and age, with some notable exceptions. digital.library.unt.edu/ark:/67531/metadc9092/
The Effectiveness of the Geriatric Depression Scale to Distinguish Apathy From Depression in Alzheimer's Disease and Related Dementias.
Early detection of Alzheimer's disease (AD) and related dementias in the elderly is critical for improving treatment methods and is a necessary component for improving public health interventions. One of the earliest and most common behavioral syndromes of AD is apathy and is associated with executive dysfunction. Apathy in AD is often misdiagnosed as depression due to an overlap in symptoms. Studies that have found depression to be associated with executive dysfunction have not always controlled for the presence of apathy. The Geriatric Depression Scale (GDS) is a widely used instrument designed to assess depression in the elderly. This study utilized the GDS and a set of standard neuropsychological instruments to investigate the relationship between apathy, depression, and executive functions in individuals with AD and related dementias. The first objective of this study was to determine if apathy has a greater impact on executive functions compared to depression in AD and related dementias. The second objective was to determine the effectiveness of the GDS as a screen for apathy. The results of the analyses did not support the hypotheses. However, exploratory analyses suggested a possible non-linear relationship with apathy and various levels of dementia severity. Exploratory analysis also suggested mean levels of endorsement for apathy varied by diagnosis. Further research is warranted to investigate this relationship and the GDS endorsement patterns for caregivers regarding their impression of the demented individual. digital.library.unt.edu/ark:/67531/metadc9109/
Personality and the prediction of outcome following rehabilitation in persons with acquired brain injuries: The Millon Behavioral Medicine Diagnostic (MBMD).
Neuropsychological rehabilitation following acquired brain injury is increasingly recognized as essential with the advancements in research evidence of its effectiveness, particularly as current estimates of disability following the most common forms of brain injury (traumatic brain injury and cerebrovascular accident) are so high. Improvements in predictive capabilities of researchers and clinicians are paramount in designing effective interventions. As many variables associated with outcome following brain injury are not controllable (e.g. severity of the injury, age, education), it is essential that rehabilitation programs design interventions to target those variables that are susceptible to amelioration. While personality factors have been shown to affect outcome in other medical illnesses, only a few studies have examined the influence of personality on outcome following neurorehabilitation for acquired brain injury. The results of these studies have been mixed. This study used the Millon Behavioral Medicine Diagnostic (MBMD) to predict outcome as measured by the Mayo-Portland Adaptability Index (MPAI-4) following brain injury rehabilitation in a heterogeneous sample of persons with acquired brain injuries (N = 50). It was hypothesized that specific coping styles scales from the MBMD (Introversive, Dejected, Oppositional), which are based on Millon's personality system, would predict outcome. Results indicated that both the Introversive and Oppositional coping styles scales accounted for significant amounts of variance in outcome beyond that accounted for by the severity of the injury alone (p < .001). In both cases, individuals with mild/moderate-moderate/severe limitations following completion of the rehabilitation program had significantly higher scores on the Introversive and Oppositional coping compared to individuals with more successful outcomes. The hypothesis that a dejected coping style would predict outcome was not supported. Implications for rehabilitation are discussed in the context of Millon's personality system. digital.library.unt.edu/ark:/67531/metadc9121/
Partner abuse: Health consequences to women.
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Intimate partner violence is endemic in the United States. According to the American Medical Association (1992), one-fifth to one-third of women will sustain violence from a partner or ex-partner in their lifetime. The relevant literature was organized by ICD-9-CM categories. This study examined the health consequences of partner abuse in a sample of community women using a sample consisting of 564 women in three ethnic groups. Because prior research has failed to account for variations by type of abuse on health consequences, this study assessed psychological abuse, violence and sexual aggression by women's partners. To determine whether or not different types of abuse had an effect on women's health, hierarchical regression analyses were conducted. The regression equations were calculated for women within each ethnic group to facilitate identification of similarities and differences and to control for ethnic differences in risk for specific diseases. The results were consistent with past research on health consequences of abuse and extended the prior literature by showing that psychological abuse had a pervasive effect on health conditions, distress and use of health care resources. Additionally, ethnic differences emerged. As expected, ethnicity appeared to function as a moderator. Clinical implications and recommendations are made for future research, suggesting the development of a new assessment tool for partner abuse screening. digital.library.unt.edu/ark:/67531/metadc5534/
NEPSY profiles in children diagnosed with different ADHD subtypes.
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The purpose of this study was to determine if attention-deficit/hyperactivity disorder (ADHD) subtypes (predominantly hyperactive/impulsive, ADHD-HI; predominantly inattentive, ADHD-IA; combined, ADHD-C) exhibit distinct neuropsychological profiles, using the Attention and Executive Function subtests of the Developmental Neuropsychological Assessment, (NEPSY) and the omission and commission scores obtained on the Conners' Continuous Performance Test-II (CPT-II), a test that assesses attention processes. The sample was selected using archival data collected in a neurodevelopmental clinic over the past decade and consisted of 138 children between the ages of 6 and 12 years old. Using the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) criteria, the children were placed in either the ADHD-HI (n = 40), ADHD-IA (n = 35), or ADHD-C (n = 36) group, or a symptom free comparison group (n = 27). It was hypothesized that children with elevations on the impulsivity/ hyperactivity (ADHD-HI and ADHD-C) scale would be impaired on measures of inhibition and those with elevations on the inattention scale (ADHD-IA and ADHD-C) would be impaired on tests of attention, vigilance, and other executive functions. A one-way multivariate analyses of variance (MANOVA) was conducted (Group X Task), with significant results for overall main effect for group on the 7 dependent variables post hoc tests using the Tukey's honestly significant difference (HSD) revealed the following: the ADHD-HI group scored significantly lower on tests that require behavioral inhibition processes (Knock and Tap, Statue and CPT-Commission errors). The ADHD-IA group scored significantly lower on tests of problem-solving and planning (Tower) but not on tests of attention as was expected. The ADHD-C group scored significantly lower on tests of inhibition, attention, and other executive functions (Auditory Attention Response Set, Visual Attention, Tower, Knock and Tap, Statue, and CPT-Omission and CPT-Commission errors). Overall results suggest that the NEPSY Attention and Executive Function subtests are able to differentiate ADHD subtypes. Recommendations for future research are discussed. digital.library.unt.edu/ark:/67531/metadc5416/
Influence of executive function on medication adherence in neurologically impaired and non-impaired elderly.
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Medication non-compliance has become one of the most prevalent reasons for hospitalization and doctor's visits by the elderly. As the elderly population is more likely to have decreased cognitive abilities, it is suggested that neuropsychological factors, especially executive function, are more influential in medication non-compliance than once thought. This study looked at executive function performance on a traditional battery of neuropsychological tests, self-report of perceived ability to perform executive function tasks, and the newly developed Pillbox Test, a performance based IADL measure. The Pillbox Test is designed to replicate a type of medication-management specific IADL as a means to asses executive function. Standard executive function measures only tap a portion of executive function, but it is believed that the Pillbox Test incorporates all four theoretical domains of executive function. The multiple measures of executive function performance were compared in three prevalent subgroups of the elderly population (mixed neurological group, cardiac medical-control group, and healthy community-control group). Results found significant differences, where the community-control and cardiac groups outperformed the mixed neurological group on the large majority of executive function tasks. Smaller differences were also noted between the community-control and cardiac groups and between the cardiac and mixed neurological groups. Together, these findings provide support for the diagnostic prevalence of mild cognitive impairment in the older adult cardiac population. Results also indicated the level of executive dysfunction on standardized neuropsychological measures was highly correlated with performance on both the Pillbox Test and the IADL based Direct Assessment of Functional Status measure. Finally, the Pillbox Test has moderate to strong ecological validity with 75% sensitivity and 87.5% specificity for five or more errors on this test. digital.library.unt.edu/ark:/67531/metadc5304/
Pathophysiology and Racial/Ethnic Disparities in the Progression of Metabolic Syndrome
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Disparities exist in the U.S. between the health status of African American and Hispanic individuals and the health status of non-Hispanic Caucasian individuals across all age groups. Those minority individuals age 55 and over are more likely to suffer from specific health disparities in areas such as diabetes, heart disease, and cancer than their white majority counterparts. Among the most common chronic disorders experienced within this age group are obesity, type II diabetes and cardiovascular disease, all three of which collectively form what has recently become known as metabolic syndrome. As of 2004, metabolic syndrome is diagnosable once criteria are clinically significant for a variety of different risk factors designated by the World Health Organization. However, like many syndromes these criteria are not stable across individuals, and leaves variability between individuals being diagnosed. It has been seen that each of the above mentioned racial/ethnic groups experience the individual risk factors at disproportionate rates, making it plausible that metabolic syndrome could be experienced in distinctly different ways depending upon racial/ethnic background. Using two nationally representative data sets, it is first largely evident that African American and Hispanic individuals are reaching higher peak rates of diabetes and cardiovascular disease much earlier in age than are non-Hispanic Caucasian individuals. The study goes on to reveals that the metabolic syndrome appears to follow one underlying progressive syndrome that begins with obesity and progresses towards heart disease. Each of the racial/ethnic groups experience significantly different progressions of the syndrome across time. Behavioral analysis found significant differences in health behaviors across the three groups; however a more pervasive lack of initiative in practicing preventive health behaviors is also present. The study achieved a higher understanding of individual differences within metabolic syndrome and insight into how and at what time in the lifespan health services can be most beneficial in providing preventive services to culturally diverse populations. digital.library.unt.edu/ark:/67531/metadc5310/
Changes in Quantitative EEG and Low Resolution Tomography Following Cranial Electrotherapy Stimulation.
The effects of cranial electrotherapy stimulation (CES) on human EEG and brain current density were evaluated by quantitative electroencephalography (qEEG) and low resolution brain electromagnetic tomography (LORETA). A total of 72 research subjects were provided with a single session of CES, 38 were provided with 0.5 Hz CES while 34 were provided with 100 Hz CES. The qEEG paired t-tests revealed that in both frequencies of CES there was a significant (.05) increase in alpha relative power with concomitant decreases in delta and beta relative power. The 0.5 Hz CES decreased a wider frequency range of delta activity, while the 100 Hz CES decreased a wider frequency range of beta activity; suggesting some difference may exist in the EEG response to different frequencies of CES. The changes found in qEEG relative power were consistent with the affective and cognitive effects of CES reported in the literature, such as increased relaxation and decreased anxiety. Statistically significant changes for qEEG values other than relative power, such as coherence, amplitude asymmetry, phase lag and power ratios were also found. The LORETA paired t-tests found statistically significant (.05) increases in cortical and subcortical theta and alpha frequency current density with concomitant decreases in delta and beta current density. The effects of CES on current density varied by frequency, but did not show a differential in response based on proximity to the contacts, or structures within the brain. Statistically significant changes in current density were found in all 2394 gray matter voxels represented by LORETA, indicating a whole brain response to the CES stimulus. The qEEG and LORETA findings revealed that a single 20-minute session of CES does have a significant effect on the cortical and subcortical activity of the human brain resulting in activity consistent with decreased anxiety and increased relaxation. digital.library.unt.edu/ark:/67531/metadc5364/
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