The Cultural Context and the Psychotherapeutic Process: Toward a Culturally Sensitive Psychotherapy.

Cross-cultural psychotherapy has striven to refine its intervention strategies during the last 2 decades. However, many authors have noted that these advances seem disconnected from each other and from traditional psychotherapeutic approaches. This article offers a conceptual framework that groups very diverse psychotherapeutic approaches into 3 broad categories according to some of their basic assumptions. Some cross-cultural psychotherapeutic models are also located within these 3 categories as a means to link different and apparently fragmented cross-cultural models to traditional psychotherapeutic models. It is argued that the proposed conceptual framework allows clinicians to intervene in a more effective manner than if these different psychotherapeutic models remained fragmented and disconnected. The proposed conceptual framework allows clinicians to benefit in a coherent manner from the advantages of different psychotherapeutic recommendations. Finally, the psychotherapeutic usefulness of this model is illustrated through a case presentation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stressful events are indeed a factor in physical illness: Reply to Schroeder and Costa (1984).

This article presents a conceptual and empirical reply to the study by Schroeder and Costa (1984) that reported relations between stressful life events and physical illness are artifacts of contamination in the events measure by neurotic, subjective, and physical health influences. The present study considers potential conceptual exaggerations that (a) only retrospective studies have shown a stress–illness relation, (b) self-report measures of stressful events are virtually useless, (c) anything is better than self-report illness measures, and (d) frustration stimulated the development of models of resistance to illness. Schroeder and Costa's concern that subjective and physical status items may be present on stress measures appears exaggerated given current research approaches, and their concern about the role of neuroticism is unclear. By using two different samples and two different sets of stress items, our study provides evidence that items uncontaminated by subjectivism, physical status, and neuroticism do indeed correlate with concurrent and prospective illness. These results are at variance with the findings of Schroeder and Costa and are discussed in terms of underlying assumptions about measurement common in psychology that bear reconsideration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alternatives to a core curriculum to accomplish broad and general training: A scientist-practitioner perspective.

There has been an historical struggle in professional psychology to provide a broad and general core without identifying the critical components necessary or how these components are linked to educational and professional outcomes. A conceptual model is presented that encourages more creative approaches to broad and general education and provides a theoretical grounding for implementation of alternative approaches that lend themselves to tracking educational outcomes. Alternative methods to ensure broad and general training include (a) a greater attention to preadmission preparation and (b) the use of alternatives to core courses such as menu driven coursework, competency portfolios, and comprehensive examinations. Examples of these methods are presented in detail. Program directors, regulators, and accrediting bodies need to consider this conceptual, outcome driven model, for evaluating programs and graduates with respect to broad and general preparation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

No change in automatic function tests during uncomplicated haemodialysis

The curricula of tertiary nursing courses usually involve a number of complementary strands. These include biological sciences, social sciences, behavioural sciences, other support subjects and clinical units. These different strands each, to some extent, present the nursing student with a dilemma as they may present entirely different models of the body. Explorations of this dilemma show that students are also being presented with different models of illness and different conceptions of appropriate health care response to illness. The question is then raised as to which of these approaches most accurately reflects the realities of nursing practice.     

Expanding clinical applications of population pharmacodynamic modelling

Population pharmacokinetics or pharmacodynamics is the study of the variability in drug concentration or pharmacological effect between individuals when standard dosage regimens are administered. We provide an overview of pharmacokinetic models, pharmacodynamic models, population models and residual error models. We outline how population modelling approaches seek to explain interpatient variability with covariate analysis, and, in some approaches, to characterize the unexplained interindividual variability. The interpretation of the results of population modelling approaches is facilitated by shifting the emphasis from the perspective of the modeller to the perspective of the clinician. Both the explained and unexplained interpatient variability should be presented in terms of their impact on the dose-response relationship. Clinically relevant questions relating to the explained and unexplained variability in the population can be posed to the model, and confidence intervals can be obtained for the fraction of the population that is estimated to fall within a specific therapeutic range given a certain dosing regimen. Such forecasting can be used to develop optimal initial dosing guidelines. The development of population models (with random effects) permits the application of Bayes's formula to obtain improved estimates of an individual's pharmacokinetic and pharmacodynamic parameters in the light of observed responses. An important challenge to clinical pharmacology is to identify the drugs that might benefit from such adaptive-control-with-feedback dosing strategies. Drugs used for life threatening diseases with a proven pharmacokinetic-pharmacodynamic relationship, a small therapeutic range, large interindividual variability, small interoccasion variability and severe adverse effects are likely to be good candidates. Rapidly evolving changes in health care economics and consumer expectations make it unlikely that traditional drug development approaches will succeed in the future. A shift away from the narrow focus on rejecting the null hypothesis towards a broader focus on seeking to understand the factors that influence the dose-response relationship--together with the development of the next generation of software based on population models--should permit a more efficient and rational drug development programme.     

Meta-analysis of multiple outcomes by regression with random effects

Earlier work showed how to perform fixed-effects meta-analysis of studies or trials when each provides results on more than one outcome per patient and these multiple outcomes are correlated. That fixed-effects generalized-least-squares approach analyzes the multiple outcomes jointly within a single model, and it can include covariates, such as duration of therapy or quality of trial, that may explain observed heterogeneity of results among the trials. Sometimes the covariates explain all the heterogeneity, and the fixed-effects regression model is appropriate. However, unexplained heterogeneity may often remain, even after taking into account known or suspected covariates. Because fixed-effects models do not make allowance for this remaining unexplained heterogeneity, the potential exists for bias in estimated coefficients, standard errors and p-values. We propose two random-effects approaches for the regression meta-analysis of multiple correlated outcomes. We compare their use with fixed-effects models and with separate-outcomes models in a meta-analysis of periodontal clinical trials. A simulation study shows the advantages of the random-effects approach. These methods also facilitate meta-analysis of trials that compare more than two treatments.     

Meta-emotion and socialization of emotion in the family—A topic whose time has come: Comment on Gottman et al. (1996).

J. M. Gottman et al (see record 83:37013), proposed a conceptual framework and process-oriented model of the socialization of emotion that has proved fruitful in their own research and is likely to guide future research efforts. In this comment, aspects of their model, including the conceptualization of meta-emotion and the distinction between meta-emotion and parenting behavior, are discussed, with suggestions offered for further modifications of aspects of the model or research that is based on the model. In addition, distinctions among various modes of regulation are considered, and some implications of these distinctions for research are suggested. Furthermore, the conclusion by Gottman et al that temperament was unrelated to parents' meta-emotion is questioned in light of other data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sickness and wickedness: new conceptions and new paradoxes

This article is a discussion of the conceptual relationship between wickedness and (mental) illness, quite apart from their uses in the criminal law. One of the these defended in the article is that in ordinary language illness has lost much of its power to mitigate and excuse, so that "sickos" are treated as if they were some strange minority or political sect.     

Evidentiary pluralism as a strategy for research and evidence-based practice in rehabilitation psychology.

Objective: This article examines the utility of evidentiary pluralism, a research strategy that selects methods in service of content questions, in the context of rehabilitation psychology. Hierarchical views that favor randomized controlled clinical trials (RCTs) over other evidence are discussed, and RCTs are considered as they intersect with issues in the field. RCTs are vital for establishing treatment efficacy, but whether they are uniformly the best evidence to inform practice is critically evaluated. Conclusions: The authors argue that because treatment is only one of several variables that influence functioning, disability, and participation over time, an expanded set of conceptual and data analytic approaches should be selected in an informed way to support an expanded research agenda in which therapeutic and extratherapeutic influences on rehabilitation processes and outcomes is investigated. The benefits of evidentiary pluralism are considered, including those that help close the gap between the narrower clinical rehabilitation model and a public health disability model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance Modeling for Contractor Selection

This paper proposes a contractor selection system that incorporates the contractor’s performance prediction as one of the criteria for selection. This research was developed working with an owner organization that was interested in developing a framework for evaluating contractors for future work. A modeling framework, developed in previous research, was used to develop a conceptual model of a project that depicts a causal structure of the variables, risks, and interactions that affect a contractor’s performance for a specific project from the owner’s point of view. The conceptual model helps to identify information needed for a comprehensive evaluation; some information can be readily available from historical records, while other can be unavailable and can be replaced by estimates based on experience. Ideally, over time, the owner should collect most of the information required for future evaluations. A mathematical component of the model can generate predictions of multiple project performance outcomes for each contractor under evaluation; these predictions and a contractors’ bid prices are then used for contractor evaluation purposes.     

Health status of preweaned dairy heifers in the United States

Chronic fatigue and chronic fatigue syndrome (CFS) have become increasingly recognized as a common clinical problem, yet one that physicians often find difficult to manage. In this review we suggest a practical, pragmatic, evidence-based approach to the assessment and initial management of the patient whose presentation suggests this diagnosis. The basic principles are simple and for each aspect of management we point out both potential pitfalls and strategies to overcome them. The first, and most important task is to develop mutual trust and collaboration. The second is to complete an adequate assessment, the aim of which is either to make a diagnosis of CFS or to identify an alternative cause for the patient's symptoms. The history is most important and should include a detailed account of the symptoms, the associated disability, the choice of coping strategies, and importantly, the patient's own understanding of his/her illness. The assessment of possible comorbid psychiatric disorders such as depression or anxiety is mandatory. When the physician is satisfied that no alternative physical or psychiatric disorder can be found to explain symptoms, we suggest that a firm and positive diagnosis of CFS be made. The treatment of CFS requires that the patient is given a positive explanation of the cause of his symptoms, emphasizing the distinction among factors that may have predisposed them to develop the illness (lifestyle, work stress, personality), triggered the illness (viral infection, life events) and perpetuated the illness (cerebral dysfunction, sleep disorder, depression, inconsistent activity, and misunderstanding of the illness and fear of making it worse). Interventions are then aimed to overcoming these illness-perpetuating factors. The role of antidepressants remains uncertain but may be tried on a pragmatic basis. Other medications should be avoided. The only treatment strategies of proven efficacy are cognitive behavioral ones. The most important starting point is to promote a consistent pattern of activity, rest, and sleep, followed by a gradual return to normal activity; ongoing review of any 'catastrophic' misinterpretation of symptoms and the problem solving of current life difficulties. We regard chronic fatigue syndrome as important not only because it represents potentially treatable disability and suffering but also because it provides an example for the positive management of medically unexplained illness in general.     

Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models.

The regression models appropriate for counted data have seen little use in psychology. This article describes problems that occur when ordinary linear regression is used to analyze count data and presents 3 alternative regression models. The simplest, the Poisson regression model, is likely to be misleading unless restrictive assumptions are met because individual counts are usually more variable ("overdispersed") than is implied by the model. This model can be modified in 2 ways to accommodate this problem. In the overdispersed model, a factor can be estimated that corrects the regression model's inferential statistics. In the second alternative, the negative binomial regression model, a random term reflecting unexplained between-subject differences is included in the regression model. The authors compare the advantages of these approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptual models of aging: The challenge of a new frontier.

Explores a range of social, professional, and scientific conceptual models to examine their potential impact on the scientific and professional approach to the aging. These models include an economic/productive model, the behavioral medical model, and conceptual models of mental health care. Narrow models have led to beliefs, training, and approaches to practice that reinforce the models and perpetuate a mythology of aging to the detriment of all involved. An opportunity to broaden conceptual horizons by learning about the aged is described. It is proposed that a biopsychosocial model best conceptualizes the complexity of the situation. A commitment to a broad model must incorporate a stance by which strategies are examined in terms of how effective they are, where they are best applied and where they are appropriate, what insights they provide, what risks and benefits accrue to patient and family, and who makes decisions about care. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The case for performance-based instructional models.

Examines evidence supporting performance-based instructional models. Performance-based instructional models posit change in students' classroom behavior and academic achievement to be a function of changes in instruction. These models stand in contrast to other models of schooling evident in the literature that are based on variables not readily alterable or under the control of teachers (e.g., socioeconomic status); these models therefore, have limited implications for instructional practice. A conceptual model for understanding the alterable elements and outcomes of the classroom instructional environment is described. The relative fit of the conceptual model in comparison to 2 different alternative models is examined. A conceptual model that included student engagement as a construct mediating the effects of instruction and achievement outcome is supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decision rules for selecting effect sizes in meta-analysis: A review and reanalysis of psychotherapy outcome studies.

This study deals with some of the judgmental factors involved in selecting effect sizes from within the studies that enter a meta-analysis. Particular attention is paid to the conceptual redundancy rule that Smith, Glass, and Miller (1980) used in their study of the effectiveness of psychotherapy for deciding which effect sizes should and should not be counted in determining an overall effect size. Data from a random sample of 25 studies from Smith et al.'s (1980) population of psychotherapy outcome studies were first recoded and then reanalyzed meta-analytically. Using the conceptual redundancy rule, three coders independently coded effect sizes and identified more than twice as many of them per study as did Smith et al. Moreover, the treatment effect estimates associated with this larger sample of effects ranged between .30 and .50, about half the size claimed by Smith et al. Analyses of other rules for selecting effect sizes showed that average effect estimates also varied with these rules. Such results indicate that the average effect estimates derived from meta-analyses may depend heavily on judgmental factors that enter into how effect sizes are selected within each of the individual studies considered relevant to a meta-analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Somatoform disorders: Personality and the social matrix of somatic distress.

Reviews the personality traits that may contribute to somatization. Negative affectivity is associated with high levels of both somatic and emotional distress. Agreeableness and conscientiousness may influence interactions with health care providers that lead to the failure of medical reassurance to reduce distress. Absorption may make individuals more liable to focus attention on symptoms and more vulnerable to suggestions that induce illness anxiety. More proximate influences on the selective amplification of somatic symptoms include repressive style, somatic attributional style, and alexithymia; however, data in support of these factors are scant. Most research on somatoform disorders confounds mechanisms of symptom production with factors that influence help seeking. Longitudinal community studies are needed to explore the interactions of personality with illness experience and the stigmatization of medically unexplained symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Statistical adjustments and uncontrolled studies.

Many evaluations of social interventions are based on uncontrolled assignments of individuals to treatment groups. Statistical adjustments are often used to compensate for naturally occurring differences between groups. There is much confusion and controversy about the adequacy of these statistical methods. A variety of interrelated problems have been identified, including measurement error, unequal growth rates across groups, and regression artifacts. It is shown that these problems can all be subsumed under a general conceptual framework, as particular examples of model misspecification. This perspective is helpful in revealing clearly the nature of the problems posed by lack of experimental control. The important case of linear adjustment (analysis of covariance) is given special attention. An expression is derived for the proportion of bias remaining after adjustment, in terms of easily interpretable parameters. Implications of these results for research and evaluation design are considered. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prescriptive approach for counselor training.

Measured the effectiveness of A. P. Goldstein's (1973) Structured Learning Training (SLT) for teaching confrontation skills to 56 trainees varying in conceptual development (Paragraph Completion Test). Both a self-instruction approach and a standard implementation of SLT were effective for teaching confrontation skills. When trainees' conceptual level (CL) was considered, the approaches proved differentially effective (as measured by pencil-and-paper tests). Self-instruction SLT was more effective with high CL trainees than with low CL trainees; guided-instruction SLT proved more effective than self-instruction SLT with low CL trainees in each treatment. Further, differences due to instructional approach and CL failed to reach significance when the dependent variable was assessed via taped role play. Findings suggest the need for multiple ways of assessing skills as well as multiple approaches for instruction. Further investigation seems necessary to specify the variables involved in maximizing the effect of instruction. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)