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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 ...
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.
A Culturally Sensitive Intervention in Pain Management Settings: Use of Dichos in Multi-Ethnic Pain Groups.
The present study explored whether use of Spanish language sayings, or dichos, improved group climate within multi-ethnic chronic pain groups. Use of this form of figurative language fits within psychological theory identifying use of metaphor as a means of promoting change and creating new meaning. Further, metaphor use is consistent with the broader aims of experiential therapy. Group climate was measured by group members' self reports using the Group Climate Questionnaire-Short Form. A pilot study involving Latino Americans in medical and non-medical contexts aided in categorizing dichos as high versus low-relevance. It was anticipated that clients would rate high-relevance sessions as involving greater engagement, and less conflict and avoidance than low-relevance groups. Participants were recruited from four multidisciplinary pain management clinics offering similar programs. Once every four to six weeks, group leaders were provided with a list of either high or low-relevance dichos, and were blind to the existence of dichos categories. Three hierarchical regression analyses were employed to determine whether dichos relevance, characterized as low, mixed or highly relevant, contributed to variance in group conflict, avoidance and engagement. Dichos familiarity was the last variable entered into the regression equation, with gender, ethnicity and acculturation score entered in sequential fashion. Consistent with predictions, low-relevance groups yielded higher conflict scores than all groups combined. Also, high-relevance groups predicted lower avoidance when compared to all groups. In contrast to hypotheses, high-relevance groups predicted lower ratings of group engagement when compared to all groups. Post-hoc analysis indicated the mixed-relevance groups yielded significantly higher engagement scores than the low and high-relevance groups. Implications of these findings are discussed in relation to impact on approaches to group therapy with Latino American clients, and within the chronic pain population. Limitations of the study and recommendations for future research are offered.
The Cross-Validation of AD/HD Instruments and the Relationship to Neurocognitive and Behavioral Measures
The purpose of this study was twofold: to determine the construct validities of comparable AD/HD instruments that were developed according to our current, DSM-IV classification system for AD/HD; and to identify potential +neurocognitive and socioemotional markers for AD/HD. The sample consisted of 145 children ages 8 to 11 years of age who were diagnosed with Attention Deficit Hyperactivity Disorder (AD/HD), or Central Auditory Processing Disorder (CAPD). Children were administered a battery of neurocognitive tests and completed a self-report measure of personality. Parents completed several, AD/HD instruments pertaining to their children. The AD/HD instruments used in this study were the Attention Deficit Disorder Evaluation Scale-Home Version (ADDES), Attention Deficit Hyperactivity Disorder Test (ADHDT), and the Attention Problems and Hyperactivity scales from the BASC-Monitor (BASC-M). Of interest was how each AD/HD instrument compared to the DSM-IV, particularly in terms of the cross-consistency of AD/HD subtype classifications. The findings showed that the AD/HD instruments classified participants differently from the initial, DSM-IV entry diagnosis. Rates of agreement were better for some of the AD/HD instruments than for others yet there was little overall consistency. The neurocognitive measures used in the study were the Cognitive Assessment System-Basic Battery scales. The socioemotional measures used in the study were two parent-report scales from the BASC-M (Internalizing Problems and Adaptive Skills), and the child report scales from the BASC-Self Report of Personality. Results showed that the neurocognitive measures were relatively insensitive to AD/HD symptomatology while a nearly opposite trend was observed on the socioemotional measures. For the most part, participants classified as the ADHD-Combined Type (ADHD-CT), (regardless of which AD/HD instrument was used) had the most significant impairment in areas of social functioning and emotional symptoms across parent and self-reports.
Differences in Perceptual-motor Functioning Between Blind and Sighted Adults: a Neuropsychological Perspective.
The purpose of the study was to explore perceptual-motor differences between blind and sighted adults from a neuropsychological perspective, and to analyze differences within the blind group. Perceptual-motor abilities were examined using the Comprehensive Vocational Evaluation System (CVES), a vocational rehabilitation and neuropsychological battery designed for use with blind populations. The data were processed using Analysis of Covariance. Results showed that sighted persons had better motor abilities, while persons with blindness were more skilled at haptic identification of shape and texture. Analysis within the blind group showed that texture identification skills are better when blindness occurs earlier in life and to the extent that the blindness is total. Later onset blindness and the retention of some functional vision may not lead to a refocusing of attentional states necessary to develop haptic images. New neural connections may develop in persons with congenital/total blindness, a hypothesis in line with recent neuroradiological findings that occipital lobe activation occurs when congenitally blind individuals engage in tactile processing tasks. One implication of the findings is that teaching individuals who retain some functional vision to read Braille is probably counterproductive. These individuals would be better served by learning to use a CCTV and large print books. Future researchers should examine blindness from a multivariate perspective, examining subsets of blind groups based on age at onset, visual status, and other pertinent variables. Other implications are discussed and recommendations for future research are provided.
The Role of Acculturation in the Health Belief Model for Mexican-Americans with Type II Diabetes
Diabetes has alarming prevalence rates not only in the U.S., but also worldwide. Ethnicity plays a large role with Hispanic-Americans having one of the highest prevalence rates. Diabetes is a complicated disease that requires significant lifestyle modifications. The health belief model (HBM) has been investigated as a theory to explain behavior change. However, little research has been done to determine its utility to Mexican-Americans. In the current study, participants were Mexican-American adults (N = 66) with type II diabetes who were recruited from family medicine clinics. Self-report questionnaires included the General Acculturation Index (GAI) and the Multidimensional Diabetes Questionnaire (MDQ). Participants had the option to complete them in either Spanish or English. Laboratory values were collected from medical charts. A MANCOVA indicated that two variables were significant, perceived severity (PS) and misguided support behaviors (MSB), p < .05. With respect to the HBM, PS was identified as a component of an individual's perception, acculturation was a modifying factor, and MSB was a component of the likelihood to change factors. These three affected glycemic control. Odds ratios determined that individuals with better glycemic control had less perceived severity and less misguided supportive behavior. Individuals with the least acculturation were more likely to have best glycemic control. Significant results were found for each of the three main columns of the model suggesting that the HBM has utility for the Hispanic-American population with type II diabetes. Results suggest that health care personnel should be aware of the ramifications of patients' perceived severity of their illness as well as the amount the "nagging" type support they receive from friends and family on glycemic control. This awareness can lead to the development of interventions aimed at improving glycemic control and the quality of life in Mexican-Americans with diabetes. Specifically, programs focused on incorporating the family ...
Anger Reduction in Closed Head Injured Individuals with Group Social Skills Training
In the present study, an anger management treatment program was compared to a pseudo-social skills training program (self-help group) and waiting list control group to determine its effectiveness in reducing irritable/angry behavior in head injured subjects. Subjects consisted of 28 adults with previous head injury trauma who had difficulty with excessive irritability and anger. Subjects averaged 35.4 years of age and had an average of 8.9 years post head injury. Treatment consisted of 10 group sessions over a five week period. Anger management training was designed to teach subjects self management skills aimed at reducing the frequency of angry acting out behavior. Training methods included role playing, relaxation training, assertiveness training and cognitive restructuring. The pseudo-social skills training group was a self-help group designed to encourage discussion of irritability problems without teaching specific coping techniques. To assure some degree of homogeneity in cognitive abilities among subjects, minimum eligibility scores were required on five subtests of the Wechsler Adult Intelligence Scale - Revised and the Peabody Picture Vocabulary Test. Dependent measures were pre and posttreatment scores obtained from five categories of the Katz Adjustment Scale - Relative form: belligerence, negativity, general psychopathology, social obstreperousness, and social role functioning. In addition, pre and posttreatment recordings of observed angry/irritable behavior in the subjects were obtained from a significant other. Results failed to reveal statistically significant differences on the dependent measures between the three study groups. In addition, analysis failed to reveal any significant variables that predicted outcome. It is evident that much more organized research is needed to further investigate the possibilities of treatment for various problems encountered by those with head injuries.
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.
A Confirmatory Factor Analysis of WRAML Scores in a Group of Academically Talented Students
The purpose of this study was to confirm the original factor structure of the Wide Range Assessment of Memory and Learning (WRAML) utilizing a non-clinical adolescent population. Additional analysis examined the relationship between SAT-M scores and spatial relations ability. Exploratory analyses were conducted to determine ethnic and gender differences on the WRAML and subtests from the DAT. Sixty-four academically talented adolescents completed the WRAML and the mechanical reasoning and spatial relations subtests from the Differential Aptitude Test (DAT). The confirmatory factor analysis found the data obtained to not be a good fit for the factor structure of the WRAML (Sheslow & Adams, 1990). Additional confirmatory analyses were conducted which examined data fit of a three factor model found by reanalyzing the standardization data (Burton et al., 1996; Wasserman & Cambias, 1991) as well as two null models. The data failed to fit any of these three models. No support was found for the second hypothesis that predicted a positive relationship between SAT-M scores and spatial relations ability. Ethnic and gender differences on the WRAML and two DAT subtests were examined and discussed. Limitations of this study were reviewed which may have accounted for the overall lack of results.
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.
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.
Behavior Patterns among Children with a History of Metopic Synostosis
Metopic synostosis is a condition in which the metopic suture of the human cranium fuses prematurely and may be related to poor behavioral inhibition leading to behaviors commonly associated with Attention-Deficit Hyperactivity Disorder (ADHD). The purpose of this project was to examine the behavior patterns among children with a history of metopic synostosis. It was hypothesized that children with a history of metopic synostosis would exhibit many of the same behavioral patterns associated with ADHD. It was also hypothesized that children with a history of simple synostosis not involving the metopic suture would not evidence this type of behavioral pattern. In order to test these hypotheses, the behavior of three groups of children was compared including (1) children who had a history of metopic synostosis (M= 7.63 years, SD = 1.92 years), (2) children who had a history of simple craniosynostosis not involving the metopic suture (M= 7.54 years, SD = 1.88 years), and (3) a group of children diagnosed with ADHD (M=7.78 year, SD = 1.87 years). It was found using the Home and School versions of the Attention Deficit Disorders Evaluation Scale (ADDES) that children with a history of metopic synostosis demonstrate significantly more behavioral disturbances than children with a history of simple craniosynostosis not involving the metopic suture. Using the BASC Teacher Rating Form it was found that children with a history of metopic synostosis have a behavior pattern similar to children diagnosed with ADHD and a dissimilar behavior pattern compared to children who have a history of craniosynostosis not involving the metopic suture. Using the BASC Parent Rating Form it was found that children with a history of metopic synostosis have a behavior pattern dissimilar to children diagnosed with ADHD and a dissimilar behavior pattern compared to children who have a history of craniosynostosis not involving ...
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 ...
Women Receiving Genetic Counseling for Breast Cancer Risk: Cancer Worry, Psychological Distress, and Risk Recall Accuracy
This follows an earlier study of the same data set, which, through its findings, presented new questions that are investigated in this study. Both studies used a prospective controlled design, wherein women receiving genetic counseling for breast cancer risk were randomized into two groups. Subjects receiving an audiotaped recording of their genetic consultation (tape group) were compared to subjects who also had a genetic consultation but did not receive an audiotaped recording of it (no-tape group). Participants were drawn from attendees at the genetic clinics of two London hospitals and included 115 women with a family history of breast cancer. Cancer worry and psychological distress were assessed before genetic consultation (baseline), and at one- and six-month follow-ups by post. Objective risk was estimated by the geneticist during the consultation, and subjective risk was assessed at one month follow-up. The goals of the current study were to investigate relationships between cancer worry, psychological distress, and recall of genetic risk for breast cancer in a sample of women receiving genetic counseling for breast cancer risk, and to investigate the role sociodemographic variables on cancer worry, psychological distress, or risk recall for these women. Results for this sample of women with a family history of breast cancer found that there were consistent relationships between cancer worry, psychological distress, objective risk, and subjective risk before and after genetic consultation. This suggests that women=s psychological responses are appropriate to their level of cancer risk. There were no differences found between the tape and no-tape groups for objective or subjective risk, or for nearness of recall accuracy or degree of under-/over-estimation. Provision of an audiotaped recording of the genetic consultation did not appear to enhance recall of risk information. The role of sociodemographic variables on the psychological and risk variables assessed in this study was very ...
Assessment of Brain Damage: Discriminant Validity of a Neuropsychological Key Approach with the McCarron-Dial System
The present study investigates the predictive accuracy of a key approach to interpretation of the verbal-spatialcognitive (VSC) and sensorimotor (SM) factors of the McCarron-Dial System (MDS). The subjects include 99 brain damaged and 30 normal adults. The following research questions are addressed: (a) Does the neuropsychological key classify brain damaged and non-brain damaged subjects at a level significantly above chance? (b) Among the brain damaged subjects, does the neuropsychological key identify right brain damage, left brain damage and diffuse brain damage at an accuracy level significantly above chance? (c) Is the neuropsychological key approach superior to the empirical model derived from discriminant function analysis in predictive accuracy? The neuropsychological key correctly classifies 90% of the cases as brain damaged and 90% of the cases as non-brain damaged, for a total of 89.9% predictive accuracy. The obtained Kappa coefficient of .74 is statistically significant. The key accurately classifies 71.4% of the brain damaged group as right damage, 70% as left damage, and 93.8% as diffuse damage, for a total predictive accuracy of 7 9.5%. The Kappa coefficient of .68 is statistically significant. Chi square analysis of the difference between the key approach and multiple discriminant function analysis reveals that no significant difference is present between the accuracy of the two approaches in differentiating between brain damaged and non-brain damaged, or in differentiating among left, right and diffuse brain damage. The results support the validity of a neuropsychological key approach to interpretation of the McCarron-Dial System, although cross-validation is indicated to confirm the stability of these results. Differences in sex, educational level and racial composition of the comparison groups may have affected the results obtained. Refinement of the key in future research and the addition of test instruments assessing memory, auditory processing, attention and emotional/behavioral variables are recommended.
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.
Predictors of Use and Outcomes of Youth and Family Centers
This study analyzed data from Dallas Public Schools and Dallas Youth and Family Centers (YFCs) to explore variables associated with referrals to and utilization of Youth and Family Centers. Data from students enrolled in third, eighth or tenth grade during the 1996-1997, 1997-1998 and 1998-1999 school years were analyzed to determine the reasons for YFC referral and utilization, and to compare standardized test scores and attendance. Of the 6956 students in third, eighth and tenth grades initially referred to YFCs during those three school years, 5173 (74.3%) made at least one YFC visit. The 5173 students made an average of 2.69 visits and accessed an average of 1.18 services per year. Medical visits accounted for 42.5% of YFC visits, and mental health visits accounted for 46% of YFC visits. Results of logistic regression analyses indicate a significant difference for utilization upon referral and continued use of the YFC when the constant is compared to a set of predictor variables. For both analyses, the predictor variables were Chapter I status, LEP status, reason for referral, gender, special education status, ethnicity, distance from home school to referral YFC, food stamp eligibility and referral source. While outcome data regarding attendance and scores on standardized tests was limited to records available, results suggest that mean reading scores for eighth graders were significantly higher during Year 1 for the group that accessed YFC services. School attendance was better for eighth graders who made continued use of a YFC. Use of medical services by third graders was associated with a gain in attendance rather than a slight loss for the third graders who did not access medical services upon referral. Results of this study were limited by missing data for several records. The competitive atmosphere of health care service delivery and the practical need to know ...
Mirthful Laughter and Directed Relaxation: a Comparison of Physiological Response
The differences among certain physiological changes occurring in response to mirthful laughter, directed relaxation, and verbal speech were investigated. These changes included amount of muscle tension, as measured with surface electromyography, in the forehead and in the upper body as recorded from the forearms bilaterally, peripheral surface skin temperature, heart rate, and respiration rate. The study sought to determine whether the net effect of laughter, as measured on these five variables after a three-minute refractory period, is a more relaxed state than existed before the laughter. Determination of the similarity between the changes following laughter and the changes following directed relaxation was made in comparison with the changes following verbal speech. Factors of prior anxiety, pre- and post-self-esteem levels, humor level, and laughter intensity were examined. Historical and theoretical perspectives were reviewed, as well as the known information on physiological responses to laughter.
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.
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.
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.
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.
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 ...
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 ...
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
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.
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.
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
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 ...
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 ...
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 ...
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.
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 ...
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.