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- 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.
- Autonomic Balance and Control of Stress for Participants Identified as High or Low Hostile and as Having a Positive or No Family History of Cardiovascular Disease
- The influence of autonomic activation in response to controllable versus noncontrollable stress, anger imagery induction, and relaxation imagery was studied among 80 participants between the ages of 18 and 34. Participants differed in level of trait hostility as assessed by the Irritability Subscale of The Buss-Durkee Hostility Inventory (Buss & Durkee,1957) and the Ho scale of the Cook-Medley Hostility Inventory (Cook & Medley, 1954). Groups were further subdivided with regards to either having a positive family history of cardiovascular disease or having no significant history. Results were obtained through analyses of electrocardiograph R-R intervals which produced an index of autonomic nervous system activation. Findings supported hypotheses involving the relations between autonomic balance and stress and hostility for the female and male populations. Among both populations, parasympathetic regulation was diminished during anger induction for individuals with high levels of trait hostility and having a family history of cardiovascular disease. Similar results were obtained for men during relaxation imagery induction.
- QEEG and MMPI-2 patterns of adults reporting childhood sexual abuse: Determining differences and predictor models.
- Childhood sexual abuse (CSA) has been linked to a number of adult psychological maladies. The MMPI-2 has shown specific patterns such as an inverted V in the validity scales, a floating profile, and a 4-5-6 configuration to be present more often in adults who have experienced childhood trauma. Both children and adults who have experienced trauma have shown a number of neurophysiological differences when compared to non-traumatized individuals. However, little research has looked at differences in quantitative electroencephalography (QEEG) patterns in these individuals. The purpose of this study is to determine differences seen in the MMPI-2 and the QEEG when comparing adults who report CSA to adults who deny any history of childhood abuse. Differences between the two groups in MMPI-2 basic scales and supplementary scales PK and PS were determined. This study also examined the ability to correctly classify individuals into the two groups using three patterns seen in the MMPI-2 basic scale profiles (inverted V, floating profile, and 4-5-6 configuration). In addition, this research included exploratory analyses to develop predictor models for CSA group membership. Predictors in the models were derived from MMPI-2 scales, alpha relative power at each of the 19 sites in the International 10/20 electrode placement system, as well as alpha/delta, alpha/theta, and alpha/beta ratios at each of the 19 sites. A total of 46 participants were included in this study, 24 from archived files and 22 newly recruited individuals. Each participant received a MMPI-2 and a QEEG. Significant differences were found between the MMPI-2 scores of the two groups, but MMPI-2 patterns were unable to correctly classify individuals. Models were found which were clinically relevant and statistically significant. The models were based on depression and social maladjustment. The depression models included scales F and 2 of the MMPI-2 and alpha relative power at left frontal sites. The social maladjustment models included scales 4 and 8 of the MMPI-2 and alpha relative power at temporal sites. These findings support previous research showing higher levels of pathology in MMPI-2 profiles and evidence for temporal and left-frontal differences in adults who report CSA.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Improving the Definition of Exercise Maintenance: Evaluation of Concepts Related to Adherence
- Physical activity has been demonstrated in the literature as an effective way to reduce the risk for development of chronic disease. The Transtheoretical Model (TTM) of behavior change has been developed as a means to predict and facilitate movement into healthier lifestyle behaviors. The model is centered on "stages of change", which describe a continuum of readiness to engage in a health behavior change. Stages contain temporal, qualitative, and quantitative characteristics. This was a six-month study that evaluated the effectiveness of stage-matched (theorized to be pertaining only to the maintenance stage of change) vs. generic (theorized to be pertaining to anyone, regardless of stage) newsletters in assisting subjects to attain the Maintenance stage of change. It also sought to identify further qualitative characteristics that can differentiate between the Action and Maintenance stages of change. Results indicated that monthly stage-matched newsletters were no more effective in helping subjects reaching Maintenance than were the generic newsletters. Exerciser self-schema was related to stages of change, but those relationships differed from baseline to six-month follow-up, indicating development of exerciser self-schema during the study period. Implications of this are discussed. Other concepts discussed included "structure" of change process, in that three new scores were developed and correlated with self-efficacy as well as intercorrelated. Motivation was also evaluated and compared across levels of success at adhering to exercise during a three-month period. Limitations of the study and implications are discussed.
- The Effect of Web-Based Support as an Adjunct to a Self-Help Smoking Cessation Program
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For the past quarter century, the public has been educated and warned about the dangers of smoking, and both smokers and health researchers have been in search of cost-effective, smoking cessation programs that will lead to long-term cessation. This study used a randomized experimental design to investigate the effectiveness of adding Web-based support materials to a nationally sponsored self-help smoking intervention. There was no significant increase in abstinence rates nor progression through the stages of change by those participants who had access to the Web site. However, there were some overall significant trends that suggested these self-help interventions were successful at decreasing daily rates of smoking and nicotine dependency, as well as tended to encourage repeated quit attempts. Although Web-based supports did not appear to increase the effectiveness of the nationally sponsored self-help intervention, this study demonstrated overall 12 week follow-up abstinence rates of 30-32%--greater than what might be expected, given average success rates of other self-help interventions. This study also supports the notion that women may face additional barriers to smoking cessation. Limitations and implications for future research are discussed.
- Family Environment, Social Support, and Psychological Distress of Women Seeking BRCA1 and BRCA2 Genetic Mutation Testing
- Shared characteristics and predictors of psychological distress are beginning to be identified in research on women seeking genetic testing for BRCA1 and BRCA2 gene mutations. This study further explored patterns of psychological distress for 51 community women waiting to receive such genetic test results. There was no significant relationship between psychological distress and family cancer history, personal cancer history, social support networks, and family environment. Women in this sample tended to rely more on females and relatives for support than males and friends. Social support satisfaction was not related to gender or number of relatives providing support. Thirty-four of the 36 women classified on the family environment type were from Personal Growth-Oriented families. Comparisons with normal and distressed family means revealed increased cohesion and expressiveness with decreased conflict, indicative of supportive family environments. Limitations and implications are discussed.
- 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.
- Treatment efficacy in a chronic pain population: Pre- to post-treatment.
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The purpose of the current study was to investigate the effects of a multidisciplinary pain management program on five measures of subjective psychosocial factors. Ninety-five participants in the comprehensive multidisciplinary treatment group and the standard medical intervention control group were surveyed about various psychosocial factors using Axis II of the West Haven - Yale Multidimensional Pain Inventory (MPI), pre- to post-treatment. It was hypothesized that post-treatment levels would be significantly lower than pre-treatment levels for all five psychosocial variables. Additionally, gender and ethnicity variables were examined. Based on preliminary analyses indicating pre-treatment differences between the experimental and control group, five 2 x 2 x 3 analyses of covariances (ANCOVAs) were used to examine the above hypotheses. Results indicated significant differences between the treatment conditions on measures of control, with the comprehensive group feeling more in control than the standard group at post-treatment. No other significant main effects for treatment condition were found on the measures of pain severity, interference with daily activities, negative mood, or social support. However, a significant gender main effect was found for social support at post-treatment, with females reporting more social support than males. A significant gender x ethnicity interaction was also found for post-treatment control, with African-American females exhibiting higher levels of control than the other groups. Finally, a significant gender x treatment condition was found for negative mood, with males in the comprehensive group reporting more affective distress than those in the standard group. In this study, control appeared to be an integral factor in the chronic pain sample and greatly improved with comprehensive multidisciplinary treatment; while other areas of relative efficacy were not confirmed in this population.
- Development and Psychometric Validation of the State-Trait Spirituality Inventory
- The present study contributes to the widening body of spirituality research by conceptualizing it as a state-trait construct. A new measure of spirituality, the State-Trait Spirituality Inventory (STSI), was created and validated according to psychometric methods of test construction. In its current form, the STSI contains seven state spirituality items and six trait spirituality items. A thorough review of the literature identified common themes in spirituality definitions and assisted in developing definitions of trait and state spirituality. Internal consistency for the trait scale was .88 and for the state scale, .68. Good test-retest reliability was found with coefficients of .84 for trait spirituality and .81 for state spirituality. Results from a preliminary undergraduate sample as well as from the validation sample yielded a two-factor solution. In general, items determined by expert panels as trait items loaded on one factor and items deemed to be state items loaded on the second factor. Multitrait multimethod analysis yielded mixed findings for convergent, divergent, and concurrent validity for the spirituality and religiosity traits. Methods consisted of paper-and-pencil cognitive and behavioral measures. Cognitive measures were more likely to support convergent/divergent validity than were behavioral measures. A major emphasis in the study was to determine whether state and/or trait spirituality were able to predict current health status and provide evidence for predictive validity. Positive relationships were identified between trait spirituality and the mental health measures of the Short Form-36® (SF-36). In contrast, it was negatively related to the Role-Physical scale. State spirituality was inversely related to the Physical Component scale. These findings are discussed within the context of minimal research using the SF-36 and spirituality measures. The MTMM analysis was limited by available spirituality and religiosity measures that contain only cognitive or behavioral items. Suggestions for future research are offered.
- Boston Naming Test with Latencies (BNT-L)
- Although most people have experienced word-finding difficulty at one time or another, there are no clinical instruments able to reliably distinguish normal age-related effects from pathology in word-finding impairment. Two experiments were conducted to establish a modified version of the Boston Naming Test (BNT) that includes latency times, the Boston Naming Test of Latencies (BNT-L), in order to improve the instrument's sensitivity to mild to moderate word-finding impairment. Experiment 1: Latency times on the 60-item BNT (Goodglass et al., 2001) for 235 healthy adults' ages 18-89 years were collected on a representative sample. Qualitative features of the BNT items, statistical analyses, IRT, and demographic considerations of age, gender, education, vocabulary, race and culture, helped create a reduced BNT-L version with 15 of the most discriminating items. Statistically sound and sophisticated normative tables are provided that adjust for unseen covariates. Response latencies did not indicate earlier age-related decline in an optimally healthy sample. Experiment 2: Twenty-three patients referred for neuropsychological testing were administered the BNT-L. Patients referred for evaluation of mild cognitive impairment or possible dementia produced significantly different response BNT-L latencies from the healthy sample whereas patients referred for mild brain injury evaluation did not. Normal word-finding problems were discussed in terms of serial stage models of lexical access, as well as in terms of automatic and controlled cognitive processes in younger and older adults. Statistical process for creating a psychometric instrument using latencies is illustrated.
- Predicting Weight Loss in Post Surgical Laparoscopic Banding Patients
- The present study was a retrospective chart review (N=128) that investigated the efficacy of profiles derived from the three factors of the Eating Inventory® test (EI) - cognitive restraint, disinhibition, and hunger - to predict successful weight loss in post surgical laparoscopic banding patients at 6 and 9 months post surgery. Although the EI is commonly used in bariatric presurgical assessment, few studies have found consistent relationships between presurgical factor scores and subsequent weight loss in this population. Based on restraint theory, 7 profiles (high CR, super high CR, high D, super high D, high H, super high H, and null) were derived from the raw scores on the subscales of the EI and tested for weight loss predictive ability using direct logistic regression. Results were mixed with high CR, super high CR, and null profiles accurately predicting successful weight loss. Raw scores on the three factors (cognitive restraint, disinhibition, and hunger) were tested individually for predictive ability using direct logistic regression. Overall results indicated that the profile model accurately predicted more cases than the general factor model. This study significantly contributes to both the bariatric presurgical assessment literature and the restraint theory literature. Suggestions for future research are offered.
- 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.
- 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).
- 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.
- 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.
- Acculturation Level, Generational Status and Gender: Their Role in Acculturative Stress in Young Adolescent Mexican Americans
- The purpose of this study was to determine relationships between acculturation level, generational status, and gender with acculturative stress. Acculturation level was determined by the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) and acculturative stress was determined by the Societal, Attitudinal, Familial and Environmental Acculturative Stress Scale-Children's Version (SAFE-C). Subjects included 1268 Hispanic children ages 11-15. In order to validate the usefulness of the ARSMA-II with this sample, analyses were conducted between acculturation level and generational status. The Pearson product moment correlation (r=.44) and the ANOVA between the mean acculturation score and generational status were significant. However, the mean acculturation score from this study was considerably lower than the ARSMA-II score; therefore, new acculturation levels were developed to establish local adolescent norms for the ARSMA-II. All analyses involving acculturation levels were conducted using both the ARSMA-II and new acculturation levels because 300 subjects were reclassified with the new norms. Significant results were similar using both acculturation levels; however, there were more between group differences using the new acculturation levels. It was hypothesized that as acculturation level increased toward the Anglo culture, acculturative stress would decrease. The one-way ANOVA confirmed this relationship. It was also hypothesized that as generational status increased, acculturative stress would decrease. A one-way ANOVA also supported this hypothesis. In order to replicate previous findings on gender, a one-way ANOVA was conducted with acculturative stress and acculturation level. Results for both were non-significant. Overall findings indicate that generational status and acculturation level have a significant impact on acculturative stress in Hispanic children; however, gender does not seem to be a factor. Findings emphasize the importance of addressing cultural issues in the assessment, intervention, and treatment of acculturating Hispanic children. Furthermore, the ARSMA-II appears to be a useful instrument in assessing acculturation level in young adolescent Hispanics though new local adolescent norms for the ARSMA-II were developed from this study.
- The utility of the McCarron-Dial System in determining location of brain lesion.
- Among the goals of neuropsychological assessment are to detect the presence of brain damage, localize which areas of the brain may be dysfunctional, and describe subsequent functional impairments. The sensitivity of neuropsychological instruments in carrying out these functions has long been a question of debate. The purpose of the present study was to determine the utility of various performance level indictors and lateralizing indicators from the McCarron-Dial System Neuropsychological Assessment Battery (MDS) in ascertaining the presence or absence of brain damage as well as location of lesion. Models used in the present study appear to provide increased classification accuracy compared to other studies utilizing the MDS. The MDS was also shown to be comparable to other well-known neuropsychological batteries, including the Halstead-Reitan Neuropsychological Test Battery (HRB) and the Luria-Nebraska Neuropsychological Battery (LNNB) with regard to distinguishing between those with brain damage and normal controls, and also localizing brain lesion. The results of this study offer clinicians parsimonious models to evaluate for presence of lesion and its location so this information may be used to make accurate, thorough diagnoses and appropriate treatment and rehabilitation recommendations.
- Identifying AD/HD subtypes using the cognitive assessment system and the NEPSY
- The purpose of this study was to examine the ability of the Cognitive Assessment System (CAS) and the NEPSY, A Developmental Neuropsychological Assessment, to differentiate between the subtypes of Attention Deficit/ Hyperactivity Disorder (AD/HD). The CAS and NEPSY are neuropsychological instruments which provide norms for AD/HD children in general. This study examined the performance of the two subtypes of AD/HD on the CAS and NEPSY. In addition, this study examined the performance of the two AD/HD groups on the Screening Test for Auditory Processing Disorders (SCAN). Since AD/HD children tend to have difficulty with language, the SCAN was used to determine if any of the AD/HD subjects had auditory processing difficulties that might impact their performance on the CAS and/or NEPSY subtests. The sample consisted of 118 children between the ages of 8 and 12 years of age. Using the DSM-IV criteria, the children were diagnosed as having three types of AD/HD: A Predominantly Hyperactive-Impulsive Type (AD/HD-HI), a Predominantly Inattentive Type (AD/HD-I) and a Combined Type The subtypes were also identified by the Attention Deficit Disorders Evaluation Scale-Home Version (ADDES-H). Only two subtypes, AD/HD-I and AD/HD-C, were identified by the ADDES-H. There were not enough AD/HD-HI subjects to include in the study. Therefore, this study focused on the AD/HD-I and AD/HD-C subtypes. A binomial logistic regression analysis was conducted on the AD/HD-I and AD/HD-C subtypes with selected subtests of the NEPSY and the four PASS Scales of the CAS. Results indicated a significant difference between the AD/HD-I and AD/HD-C groups on the Tower subtest of the NEPSY and the Planning Scale of the CAS. The Tower and the Planning Scale are both purported measures of executive functioning; however, results of the Planning Scale were in an unexpected direction. No significant difference was found between the two AD/HD groups on the other subtests examined. The results of the SCAN analysis suggested there were no significant differences in auditory processing between the two AD/HD groups. Recommendations for future research are discussed.
- 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.
- 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.
- 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.
- 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.
- Treatment Outcomes Related to EEG-Biofeedback for Chemical Dependency: Changes in MMPI-2 (University of Minnesota) Personality Measures and Long Term Abstinence Rates
- Peniston and Kulkosky (1989, 1990) demonstrated the effectiveness of alpha-theta EEG-Biofeedback (EEG-BFB) in treating inpatient alcoholics noting significant improvements in depression, psychopathology, serum β-endorphin levels, and abstinence rates. The present study is an extension of a previously unpublished replication of the Peniston EEG-BFB protocol with 20 chemically dependent outpatients (Bodenhamer-Davis, Callaway, & DeBeus, 2002). Fifteen subjects were "high risk for re-arrest" probationers. Data for the EEG-BFB group was collected from archival records. Subjects completed an average of 39 sessions (SD = 6.096), with 33 of those being EEG-BFB. Pre/post-treatment MMPI-2s (University of Minnesota) were collected and follow-up (4-11 years) data obtained (abstinence rates, re-arrests in some cases). Treatment effects were evaluated by comparing assessment data (pre/post) and documenting abstinence rates. Post-treatment MMPI-2 results were within normal limits, with several scales significantly reduced from baseline suggesting less psychopathology. Results were then compared to 20 subjects receiving standard addiction treatment (OT-CD group), but not EEG-BFB. OT-CD subjects completed a 2-week inpatient program followed by 18 outpatient sessions. Pre/post assessment and follow-up data was collected on the OT-CD group. The OT-CD group's post-assessment results showed three elevations (MMPI-2 scales 4/6/8), suggestive of characteriological problems. Post-MMPI-2 results of the two groups were compared via ANCOVAs. Findings indicated no significant differences between groups on targeted scales; however, there was a trend for the EEG-BFB group to have lower scores. Follow-up data was obtained on 13 EEG-BFB subjects. Results indicated 92% (n = 12) were sober, with 8% (n = 1) claiming significantly reduced alcohol intake. Probationer re-arrest and revocation rates were collected on the subset of probationers (n = 14 out of 15). The majority of the probationers (79%, n = 11) had not been re-arrested nor had their probation been revoked. Short-term follow-up information (35-131 days post-assessment), available at the time of writing, for the OT-CD group (N = 13) showed 85% (n = 11) were sober, with 15% (n = 2) relapsed. Limitations and implications of the study are discussed.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Organization of Narrative Discourse in Children and Adolescents with Acute Traumatic Brain Injury
- Children with a recent history of TBI often demonstrate impaired memory, which can be affected by impaired attention, processing speed or impaired verbal information processing. The purpose of this study was to determine if qualitative differences exist among the narrative recall of TBI patients that is not adequately accounted for by standard scoring methods. Sixty-six TBI subjects ranging in age from 6 to 16 were given the Wide Range and Memory and Learning (WRAML) Story Memory subtest and selected subtests from the Wechsler Intelligence Scale for Children - Third Edition (WISC-III). Mean elapsed time since injury was 53 days. Recall of the story on the WRAML subtest was hand-recorded by the examiner. A supplemental scoring method accounted for differences in length, errors, and disorganization. Comparisons were made to a randomly selected control group consisting of 16 hospitalized subjects between 7 and 15 years with no history of head injury, neurological condition or event. Findings suggest the WRAML Story Memory subtest is relatively robust in providing information regarding the quality of recall, with the exception of not accounting for the addition of erroneous details. Subjects with both cortical and subcortical injuries were more likely to add superfluous details to their stories. Results also demonstrated significant differences between the TBI subjects and control group in how well the stories were recalled, primarily in the order of details recalled and in retention after a 30 minute delay. Location was not a significant predictor of narrative organization. Although using this comprehensive supplemental scoring system a regular basis has practical limitations, hand-recording the narrative takes relatively little time and does appear to provide useful additional information concerning the nature of the child's verbal memory difficulties. Furthermore, the more knowledgeable the child, parents and teacher are about these difficulties and about remediation strategies, the more likely the child will have a successful learning experience upon return to the classroom.
- Acculturative Processes and Their Impact on Self-Reports of Psychological Distress in Mexican-American Adolescents
- The current study examined the effects of acculturative processes on the self-report of behavioral problems in Hispanic children ages 11-14. Acculturation was measured by the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) (ã Sage Publications, Thousand Oaks, CA, www.sagepub.com) (Cuellar, Arnold, and Maldonado, 1995) and the self-report of behavioral symptoms was assessed using the Youth Self-Report (ã T.M. Achenbach, Burlington, VT, www.aseba.com) (Achenbach, 1991). It was hypothesized that while both the linear and orthogonal categories of acculturation would account for a significant proportion of the variance in behavior problems in this age group, the orthogonal model would account for a larger proportion of variance due to its multidimensional nature. As well, it was hypothesized that the experimental Marginalization scales of the ARSMA-II would be predictive of behavioral problems. Multivariate analysis of variance was used to test these hypotheses and results were non-significant for the linear, orthogonal, and marginalization categories. The effects of the ethnic/cultural homogeneity of the region from which the sample was drawn, the buffering of social support, and the developmental aspects of ethnic identity are discussed as factors which may have influenced the potential impact of acculturative stress on psychological and behavioral functioning.
- Treatment Effects Related to EEG-Biofeedback for Crack Cocaine Dependency: Changes in Personality and Attentional Variables
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EEG biofeedback (neurotherapy) has been demonstrated as effective in the treatment of alcoholism, as evidenced by Peniston and Kulkosky's research efforts. These neurotherapy pioneers evaluated the efficacy of alpha-theta brain wave biofeedback as a treatment for chronic alcohol abuse, citing 80% abstinence rates as measured by improvements in psychopathology, serum beta endorphin levels, and long-term alcohol abstinence. Most research with alpha-theta EEG biofeedback has addressed alcohol addiction. Cocaine is now considered to be the most common drug problem of patients entering treatment for drug abuse. To date, only one controlled study has been published that researched alpha-theta neurofeedback in the treatment of "crack" cocaine addiction. The present study was an extension of a 4-year EEG-biofeedback treatment outcome project underway at a faith-based homeless mission in Houston, Texas, with male "crack" cocaine addicts. Changes in personality, attention, and impulsivity were measured following 30 sessions of a non-individualized EEG -biofeedback protocol. Experimental subjects received a variant of the Peniston-Kulkosky alpha-theta protocol for 30 sessions while controls received all elements of the experimental protocol except the EEG biofeedback. Assessment measures included the MMPI-2 and the IVA. Although experimental subjects showed greater mean improvement on most MMPI basic scales and all IVA Attention related measures, results indicated no significant differences between control and experimental groups. The present study did not result in significant differences between control and experimental groups on attentional or personality variables in crack cocaine addicts. Implications and limitations of the study are discussed.
- The Effectiveness of an Electronic-Mail Campaign to Modify Stress Levels, Mood States, and Coping Techniques Among Employed Adults
- The present study was conducted to explore the effectiveness of a worksite stress management program delivered via electronic mail (e-mail). One hundred and thirty-seven employed adults (36 males, 102 females; mean age = 29.46) from several diverse businesses consented to participate. The volunteers completed Cohen's Perceived Stress Scale, the Daily Hassles Scale, the Daily Work Hassles Scale, the TCU Self-Ratings Scales, and a demographic and opinion questionnaire. Individuals in the treatment group received e-mail messages twice weekly and had access to a website for three months about a variety of cognitive-behavioral techniques for managing worksite stress. A MANCOVA of post-intervention stress levels indicated that individuals who received the stress management messages perceived the same amount of stressors and hassles as individuals who did not receive the messages [F (5, 86) = 0.95, p = .45]. However, a MANCOVA of post-intervention perceived mood states revealed a tendency for individuals in the treatment group to be less depressed, anxious, and angry than individuals in the control group [F (3, 92) = 2.44, p = .07]. Demographic variables did not influence the outcome variables and pre- and post-test absenteeism and illness rates were similar for treatment and control groups. Coping skill usage was similar in amount and frequency, but differed in quality between the groups. The findings of the present study indicate that health promotion programs can be feasibly and effectively delivered via e-mail in the worksite.
- Clustering of Behavioral Data for Identification of Presumptive Subtypes of Attention Deficit/Hyperactivity Disorder in Children
- The objective of the present study was to investigate Amen's formulations of subtypes of AD/HD initially identified by brain imaging techniques, through the use of behavioral checklist data. And in testing Amen's theory of six separate subtypes of AD/HD, to identify and differentiate the subtypes based on symptom presentation. Data was obtained through retrospective chart reviews (N=161) of children between the ages of 5 and 12 who met the criteria for the major symptoms observed in AD/HD and were referred for a previous comprehensive AD/HD evaluation. Data from behavioral checklist (CBCL and DBRS-IV) were matched to Amen's Subtype Symptom Checklist and each subject was given a percentage score for six subtype symptoms. Cluster analysis reliably found six clusters and each subject was labeled according to their symptom presentation. The clusters found were labeled as AD/HD - Combined Type, AD/HD - Predominately Inattentive Type, AD/HD - Predominately Hyperactive-Impulsive Type, Ad/HD - Combined Type with Obsessive-Compulsive features, AD/HD - Combined Type with Obsessive/Compulsive and Conduct Disorder features and Undifferentiated AD/HD. However, the present study did not find evidence of subtypes that corresponded to Amen's Temporal Lobe ADD or Limbic ADD. Discriminant function analysis of the six clusters found that the variables in the model (symptom percentage scores) significantly discriminated the subtype classification. Also, 76% of all cases were correctly classified according to their symptom presentation. Potential limitations of the sample and the data used for interpretation were discussed. Limitations of the study warrant further investigation making use of multi-modal assessment tools which relate well with brain imaging techniques, such as neuropsychological measures of attention and concentration, laboratory based measures of activity, continuous performance tests measuring inattention and impulsivity, and QEEG data measuring brain wave information. A multi-modal approach to investigating symptom subtypes of AD/HD would likely provide increased reliability and validity of differential diagnosis, and therefore, more effective treatment of children with the presenting symptomology of AD/HD. The diagnostic and clinical implications' of each cluster subtype symptomology found in the present study was discussed as well.
- 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.
- Predictors of Successful Aging: Associations between Social Network Patterns, Life Satisfaction, Depression, Subjective Health, and Leisure Time Activity for Older Adults in India
- Aging in the new millennium is greatly influenced by both global and region-specific factors. In Asia, the aged population is increasing at a faster rate than both Europe and North America, making issues related to older adults needing immediate attention of researchers & planners. This study aims at identifying the predictors of successful aging. Successful aging as a construct often has an integration of good social engagement, sense of purpose in life, maintaining cognitive capacity and functional autonomy. One hundred fifty participants in India completed the Life Satisfaction Questionnaire, Geriatric Depression Scale, Health Awareness Schedule, and the Leisure Time Activity Record. Firstly, it is mainly evident that social support network is larger for older adults residing in a joint family as compared to a nuclear family setup. Further, married males in a joint family have the largest network size compared to all the other groups. The study however, reveals an interesting reverse trend of widowed females having a larger network size compared to widowed males. Statistical analysis found measures of successful aging to be highly correlated with each other, with subjective health and depression being significant predictors of life satisfaction. Further, life satisfaction, depression levels, and leisure time activities were all significant predictors of subjective health. Significant gender differences were found on life satisfaction and subjective health with married males living in joint families reporting the highest scores on all the above measures. In addition, widowed women showed the highest levels of depression, which relates to their lower life satisfaction, poor ratings of health and low involvement in leisure activities. The study achieved a higher understanding of successful aging and presented a novel finding of educational level being significantly correlated with all measures of successful aging. This study is the first of its kind to measure successful aging in an urban Asian-Indian population. However, more research is needed to examine other age-related variations to enable generalization of results to a larger culturally diverse population.
- Hierarchical neuropsychological functioning in pediatric survivors of acute lymphoblastic leukemia.
- Acute lymphocytic leukemia (ALL) is one of the most common types of pediatric cancers. Improvements in treatment within the last 20 years have resulted in reduced mortality and a greater focus upon quality of life. Several researchers have documented neuropsychological impairments in children following treatment for ALL; however, there have not been any comparative studies documenting differences in neuropsychological functioning based upon treatment modality despite the documented effects of radiation therapy and combined radiation/chemotherapy upon the developing brain. In addition, past studies have focused on unitary measures, ignoring the hierarchical relationship between basic cognitive functions and more abstract skills. This study examined the neuropsychological functioning of 81 children who were treated for ALL at a metropolitan children's hospital. All children were tested a minimum of two years after the final treatment session and were administered the NEPSY. Results do not support any interactions or main effects with the exception of the age of the child at diagnosis. Children diagnosed prior to the age of 5 showed greater impairments on tasks measuring attention, memory, and visuospatial reasoning in comparison to peers diagnosed after age 6.
- 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.
- Use of the Beck Depression Inventory in Northern Brazil
- The Beck Depression Inventory (BDI) is a popular screening and research instrument for measuring severity of depression. The instrument was translated to Portuguese for use in Brazil in 1979; however, it was not until recently that its psychometric properties have been tested empirically for the Brazilian population. The purpose of the present study was to explore the BDI's psychometric properties in a northern region of Brazil and to test for possible relationships between certain demographic variables and BDI outcomes. Samples used in this study were from an urban area in Roraima, the northernmost state of Brazil. The BDI showed adequate levels of internal consistency in nonclinical and clinical samples. Female respondents had significantly higher scores than male respondents. Those who had lower levels of education, income, or occupational status had significantly higher scores than those with higher levels of these variables. Adolescents had significantly higher scores than adults from all age groups except those from age 19 to 22. No significant difference was found between those who identified themselves as “indigenous” and those who identified themselves as “non-indigenous.” Regression analysis results showed that the combination of gender, education, and age best accounted for the variance in BDI scores. An ANCOVA revealed that clinically depressed adults had significantly higher BDI scores than nonclinically depressed adults. Factor analysis results showed that there were two main factors in the item structure for both female respondents and male and female respondents combined: one factor of mainly cognitive-affective items and the other factor of mainly somatic items. The results were discussed in terms of the future use of the BDI in Brazil.
- Transportation trauma and psychological morbidity: Anxiety, depression, PTSD and perceived control in a hospitalized sample.
- Transportation-related collisions are ubiquitous and often traumatic. Identifying post-collision psychological distress and the characteristics of the collision survivor that lead to distress are vital to the development of early and appropriate interventions. The goals of this study were: 1) to use a questionnaire as opposed to a typical diagnostic interview, 2) to confirm that psychological distress is present in currently hospitalized transportation-related collision survivors, 3) to confirm that different types of distress co-occur, 4) to determine if distress is more likely to occur in those who have had prior distress, and 5) to explore the relationship between symptoms of distress and perception of control by self, others, and God/Higher Power of past, present, and future collision-related events. Subjects were 100 English speaking adult inpatients, 16 years and older, who were less than 3 weeks post-injury, and receiving some rehabilitation. Participants completed a questionnaire which included the Center for Epidemiologic Studies Depression Scale (CES-D), Beck Anxiety Inventory (BAI), and Davidson Trauma Scale (DTS) as well as questions regarding demographics, details of the collision/injury, alcohol/drug use, pain, past and present stressors, social support, and perceptions of life change. Information about head injury and collision-concurrent alcohol and/or drug use was collected from the patient's medical chart. Compared to other traumatic experiences (e.g., physical/sexual abuse, war combat), transportation-related collisions share the characteristics of being sudden, unexpected, relatively brief in duration, and potentially lethal. Prior studies used diagnostic interviews to identify psychological distress in post hospitalized collision survivors. This study used questionnaire-based depression, anxiety, and trauma symptom inventories in a currently hospitalized sample and included head injured patients. As hypothesized there was a significant correlation between the CES-D total score and the BAI total score [Hypothesis 1], the DTS total score [Hypothesis 2], and collision concurrent alcohol and/or drug use (as indicated by medical chart records or score on the CAGE) [Hypothesis 3]. Further, there was a significant correlation between the patient's self-reported history of depression, anxiety, or stress reaction and CES-D, BAI, and DTS total scores, respectively [Hypothesis 4]. Also as hypothesized, perceived personal control of the past "events that caused the collision" was significantly correlated with the CES-D total score [Hypothesis 5] while perceived control of the present "life in general right now" was negatively correlated to the CES-D total score [Hypothesis 6]. Contrary to hypothesis, perceived control of the present "recovery process right now" was not correlated to the CES-D total score [Hypothesis 6] nor was perceived control of the future "preventing a collision like this from happening...again" [Hypothesis 7]. Perception of control by "others" of the present "recovery process right now" was negatively correlated to the CES-D total score. Results support the theory that perceived personal control of past traumatic events increases the likelihood of psychological distress. Some evidence of post traumatic growth was found.
- The theory of planned behavior and adherence to a multidisciplinary treatment program for chronic pain.
- The primary objective of this study was to examine the association between the theory of planned behavior (TBP) and adherence to a multidisciplinary pain center (MPC) treatment program for chronic pain. While the results of several studies have provided support for the efficacy of MPC treatment in chronic pain, the problems of adherence and attrition are important. TPB is a cognitive/social model of behavior that has been used to predict a variety of behaviors, although it has never been used to predict adherence to a multidisciplinary chronic pain treatment program. It was predicted that Adherence would be predicted by Intentions and that Intentions would be predicted by 1) Perceived Social Norms, 2) Perceived Behavioral Control, 3) Attitudes Toward New Behavior (completing the treatment program), and 4) Attitude Toward Current Behavior (maintaining current treatment and coping strategies). It was found that the total Intentions scores did not predict the total Adherence scores. However, Intentions was predicted by 1) Perceived Behavioral Control, 2) Attitudes Toward New Behavior (completing the treatment program), and 3) Attitude Toward Current Behavior (maintaining current treatment and coping strategies). The finding that Perceived Social Norms did not predict Intentions was consistent with results of previous studies with the TBP. The secondary objective was to examine the extent to which MPC treatment affects patients' attitudes towards behaviors that are associated with successful pain management. The majority of the patients (82%) developed a more favorable attitude toward the program and their average report of the importance of the program was 6.78 on a 10-point scale. The majority of patients (74%) reported experiencing a greater decrease in pain than expected, and the average amount of pain decrease was 5.39 on a 10-point scale.
- 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.