Family-based interventions for pediatric obesity: Methodological and conceptual challenges from family psychology.

Family-based interventions for pediatric obesity are defined by active parent involvement in treatment. In the current review the authors examine 31 family-based interventions with published outcome data and distinguish 4 categories of family-based interventions: (a) Target a narrow range of parent behaviors related to eating/exercise and assess change only in terms of child eating, exercise, or weight; (b) target a similarly narrow range of parent behaviors but nevertheless assess program-related changes in general parenting skills or family functioning; (c) target a broad range of parent behaviors related to general parenting and family functioning but do not assess program-related changes in these areas; and (d) target general parenting or family functioning and also assess program-related changes in these areas. The authors highlight methodological and conceptual challenges facing researchers in this area and argue for an even broader family focus in family-based interventions for pediatric obesity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological assessment as a therapeutic intervention in patients hospitalized with eating disorders.

As most psychologists are aware, there are many difficulties associated with the assessment and treatment of hospitalized individuals with eating disorders and their family members. Problems such as denial or minimization of the eating disorder, lack of motivation for change, treatment resistance, and lack of insight are common, and techniques that can diminish or eliminate these challenges are sorely needed. This article describes the clinical utility of therapeutic assessment, which is a nontraditional, collaborative approach to psychological evaluation, as an early step in overcoming assessment and treatment difficulties encountered in this population. Case examples are provided to illustrate the assessment method as a brief intervention. Possible mechanisms underlying the therapeutic effects are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research on telehealth and chronic medical conditions: Critical review, key issues, and future directions.

Objective: To provide a critical review of studies on the impact of telecommunication-based interventions for persons with chronic disabilities. Design: Only those studies that focused on specific health care or clinical interview outcomes and included at least 1 comparison condition were selected for review. Ten studies met these criteria. Results: Overall, the results of initial studies suggest that telecommunication-based interventions may be an efficient and effective way of providing services for chronically disabled populations, even for those who have no previous experience with the technologies. Conclusions: The number of controlled trials examining telecommunication-based interventions for those with chronic disabilities remains small. Future research should endeavor to increase sample size, use conceptually meaningful control groups, focus on cost utility, and investigate which types of telecommunication-based interventions provide the best match with specific populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory in pediatric patients undergoing conscious sedation for aversive medical procedures.

This study investigated preserved memory in 26 pediatric cancer patients (65% boys, 77% Caucasian, mean age = 12.5 years) undergoing midazolam-induced conscious sedation during painful medical procedures to treat hematological or oncological diseases. The sedative midazolam had a significant anterograde amnesic effect on participants' performance on a visual recognition (explicit) memory task but not on a visual perceptual facilitation (implicit) memory task. That implicit memory scores were relatively unaffected while explicit memory scores deteriorated significantly indicates that learning occurred while participants were sedated, even when participants did not recollect the learning event. These findings, which replicate those of M. R. Polster, R. A. McCarthy, G. O'Sullivan, P. A. Gray, and G. R. Park (1993) in a study of adults, have implications for the development and treatment of conditioned anxiety reactions associated with aversive medical procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conducting Psychological Research in Medical Settings: Challenges, Limitations, and Recommendations for Effectiveness Research.

Efficacy research is insufficient and ineffective in changing practice, despite a large supporting psychotherapy efficacy literature. Concurrently, demand for supporting data and the burden on everyday practice for generating these data is increasing. The disconnect between efficacy and effectiveness is due to a lack of conceptual and methodological tools for testing efficacious procedures in real-world settings, particularly medical contexts. This article articulates the position that effectiveness studies pose more complex questions that require an alteration of conceptual and methodological frames of reference in order to make behavioral services available to the broadest patient base. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is psychological research really as good as medical research? Effect size comparisons between psychology and medicine.

Researchers have looked at comparisons between medical epidemiological research and psychological research using effect size r in an effort to compare relative effects. Often the outcomes of such efforts have demonstrated comparatively low effects for medical epidemiology research in comparison with effect sizes seen in psychology. The conclusion has often been that relatively small effects seen in psychology research are as strong as those found in important epidemiological medical research. The author suggests that many of the calculated effect sizes from medical epidemiological research on which this conclusion has been based are flawed. Specifically, rather than calculating effect sizes for treatment, many results have been for a Treatment Effect × Disease Effect interaction that was irrelevant to the main study hypothesis. A technique for developing a “hypothesis-relevant” effect size r is proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

From Theory to Application and Back Again: Implications of Research on Medical Expertise for Psychological Theory.

Research directed at an understanding of medical expertise is about 30 years old, and many developments in this literature parallel progress in cognitive psychology. Over the past 15 years or so, this research became much more closely identified with particular psychological theories. Initial forays into medicine were essentially direct applications of methods developed in the psychology lab to the more natural domain of medicine, with varying degrees of success. These attempts were followed by a second wave that took the psychological theories themselves more seriously in a more thoughtful application of psychological methods to the medical domain. I will argue in the present paper that the methods and theories used in the study of medical expertise have advanced to the point that there is some reverse flow and they are providing a unique and valuable perspective on the nature of thinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telehealth and chronic disabilities: New frontier for research and development.

The primary purpose of this special section is to address key issues and current developments in telehealth outcome research for individuals with chronic disabling conditions. The special section begins with a critical review of contemporary telehealth and disability outcome research, followed by two articles that present the findings of 2 ongoing randomized controlled telehealth trials for adults with Type 2 diabetes and rural teenagers with uncontrolled seizure disorders. Future directions for outcome research on telehealth and chronic disability are discussed across all 3 articles, particularly the need for large N studies, the use of conceptually meaningful control groups and more rigorous cost utility analyses, and studies that evaluate the "best matches" among different types of telehealth interventions, specific health care concerns, and consumer populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resources for health: A primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions.

Objective: The Resources for Health trial evaluates a social-ecologically based lifestyle (physical activity and diet) intervention targeting low-income, largely Spanish-speaking patients with multiple chronic conditions. Design: A randomized controlled trial was conducted with 200 patients recruited from an urban community health center and assigned to intervention and usual care conditions. Intervention involved 2 face-to-face, self-management support and community linkage sessions with a health educator, 3 follow-up phone calls, and 3 tailored newsletters. Main Outcome Measures: Primary outcomes measured at 6-months were changes in dietary behavior and physical activity. Changes in multilevel support for healthy living were evaluated as a secondary outcome. Results: After adjustment for age, sex, language, and number of chronic conditions, significant intervention effects were observed for dietary behavior and multilevel support for healthy lifestyles but not for physical activity. Conclusion: The Resources for Health intervention provides an effective and practical model for improving health behavior among low-income, Spanish-speaking patients with multiple chronic conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Incremental Validity of Psychological Testing and Assessment: Conceptual, Methodological, and Statistical Issues.

There has been insufficient effort in most areas of applied psychology to evaluate incremental validity. To further this kind of validity research, the authors examined applicable research designs, including those to assess the incremental validity of test instruments, of test-informed clinical inferences, and of newly developed measures. The authors also considered key statistical and measurement issues that can influence incremental validity findings, including the entry order of predictor variables, how to interpret the size of a validity increment, and possible artifactual effects in the criteria selected for incremental validity research. The authors concluded by suggesting steps for building a cumulative research base concerning incremental validity and by describing challenges associated with applying nomothetic research findings to individual clinical cases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological adjustment among African American breast cancer patients: One-year follow-up results of a randomized psychoeducational group intervention.

The effectiveness of support group interventions for cancer patients has been established among White patients but has been virtually unstudied among minority patients. The current study represents the 1st randomized support group intervention targeted to African American women with breast cancer. Participants (N = 73) with nonmetastatic breast cancer were randomly assigned to an 8-week group intervention or an assessment-only control condition At 12 months, the intervention resulted in improved mood as well as improved general and cancer-specific psychological functioning among women with greater baseline distress or lower income. Subsequent research is needed to address effective methods of enrolling and following women with fewer psychosocial and financial resources, as they were the most likely to benefit from this particular intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

RCT of a psychological intervention for patients with cancer: I. Mechanisms of change.

Little is known about the therapeutic processes contributing to efficacy of psychological interventions for patients with cancer. Data from a randomized clinical trial yielding robust biobehavioral and health effects (B. L. Andersen et al., 2004, 2007) were used to examine associations between process variables, treatment utilization, and outcomes. Novel findings emerged. Patients were highly satisfied with the treatment, but their higher levels of felt support (group cohesion) covaried with lower distress and fewer symptoms. Also, specific treatment strategies were associated with specific outcomes, including lower distress, improved dietary habits, reduced symptomatology, and higher chemotherapy dose intensity. These data provide a comprehensive test of multiple therapeutic processes and mechanisms for biobehavioral change with an intervention including both intensive and maintenance phases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer patients with major depressive disorder: Testing a biobehavioral/cognitive behavior intervention.

Objective: In this Phase II trial, we evaluated a novel psychological treatment for depressed patients coping with the stresses of cancer. Effectiveness of a combined biobehavioral intervention (BBI) and cognitive behavior therapy (CBT) was studied. Method: Participants were 36 cancer survivors (mean age = 49 years; 88% Caucasian; 92% female) diagnosed with major depressive disorder. A single group pre–post design was used. Treatment consisted of up to 20 individual 75-min combined BBI/CBT sessions. Outcomes were change in interviewer (Hamilton Rating Scale for Depression; Williams, 1988) and self-rated depressive symptoms (Beck Depression Inventory—Second Edition; Beck, Steer, & Brown, 1996) as well as change in cancer relevant symptoms (Fatigue Symptom Inventory [Hann et al., 1998] and Brief Pain Questionnaire [Daut, Cleeland, & Flanery, 1983]) and quality of life (Medical Outcomes Study Short Form–36; Ware et al., 1995). Mixed-effects modeling, a reliability change index, and generalized linear models were used. All analyses were intent-to-treat. Results: Depressive symptoms significantly improved. In addition, 19 of 21 study completers met criteria for remission. Significant improvements were also noted in fatigue and mental health quality of life. Both concurrent anxiety disorders and high levels of cancer stress (Impact of Events Scale; Horowitz, Wilner, & Alvarez, 1979) were each associated with beginning and concluding treatment with greater depressive symptoms. Conclusions: CBT components were successfully incorporated into a previously efficacious intervention for reducing cancer stress. The BBI/CBT intervention warrants further research in evaluating its efficacy compared with well-established treatments for depression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An approach to the validity of the Taylor Anxiety Scale: scores of medical and psychiatric patients.

The Taylor scale is administered individually to a clinic sample of medical and psychiatric outpatients with the result that significant differences in mean scores, distributions, and the point biserial r of .57 indicate that this questionnaire can distinguish a psychiatric population from a normal one with reasonable efficiency. Sampson and Bindra's suggestion that Taylor scores within a limited range (19-33) are more likely to be associated with a clinical diagnosis of "anxious" than scores outside this range, are not borne out. Both findings were confirmed in a cross-validation study utilizing hospitalized VA medical and psychiatric patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Special series: Coping with medical illness and medical procedures.

This Special Series integrates recent progress in coping processes with the challenges of behavioral medicine. The term coping implies a reaction to stress; this series of articles considers stressors such as chronic disease (hypertension, heart disease, and arthritis), disability and death, and medical procedures (radiation therapy, childbirth, surgery, and invasive diagnostic procedures). Each study has derived a unique set of conclusions, with the common theme that preconceived notions about coping effectiveness should be replaced by empirical exploration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues.

There is an increasing demand for psychotherapy among ethnic minority populations. Yet, there is not adequate evidence that empirically supported therapies (ESTs) are effective with ethnic minorities. Ethical guidelines suggest that psychotherapies be modified to become culturally appropriate for ethnic minority persons. Conceptual approaches have identified interdependence, spirituality, and discrimination as considerations for culturally sensitive therapy (CST). However, there is no more empirical support for the efficacy of CSTs than there is for the efficacy of ESTs with ethnic minority populations. The chasm between EST and CST research is a function of differences between methods and researchers in these 2 traditions. Specific recommendations for research collaboration between CST and EST researchers are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The association of parent behaviors, chronic pain, and psychological problems with venipuncture distress in infants: The Generation R study.

Objective: To examine the association of parent behavior with infant distress during a potentially painful medical procedure. A second aim was to investigate the association of parent chronic pain and psychological problems with parent behavior and infant distress during the procedure. Design: Population-based cohort study with both cross-sectional and prospective measurements. Main Outcome Measures: Video recordings of 275 parents and their 14-month-old infant undergoing venipuncture were coded with an observational instrument to yield measures of infant distress behaviors and parent behaviors, such as reassuring, showing empathy, praising, and distracting. Parent chronic pain and psychological problems were assessed through questionnaires. Results: Infants cried 58% of procedure duration. Parent reassuring occurred 34% of procedure duration, and parent distracting occurred 37% of procedure duration. Infant distress was positively related to parent reassuring and negatively related to parent praising. Parent chronic pain was related to increased parent distracting but not to parent reassuring. Parent psychological problems were not associated with parent behavior and infant distress. Conclusion: Parent behavior rather than psychological traits is related to increased venipuncture distress in young infants. This finding suggests that the focus should be on interventions based on behavior modification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicide among patients with diagnoses of anxiety reaction or depressive reaction in general medical and surgical hospitals.

Analysis of records of Veterans Administration general medical and surgical patients with anxiety or depressive reactions, ? of whom had committed suicide and ? of whom were matched nonsuicidal controls, showed that the 2 groups were significantly differentiated on each of 23 feeling and behavior items. Also most of the cases could be categorized in patterns, called: (1) object-loss, suicides with severe interpersonal conflicts; (2) involutional, suicides with insult to their psychological integrity; (3) medical, controls with physical problems; (4) egoistic, both suicides and controls with few ties to society; or (5) preegoistic (tentatively identified), younger controls who were possibly in an earlier stage of the egoistic syndrome. An important measure against suicide is evidence that the hospital staff is interested in, and concerned about, the patient. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hope and social support as resilience factors against psychological distress of mothers who care for children with chronic physical conditions.

On the basis of the multivariate conceptual model proposed by J. L. Wallander et al (1989), perceptions of hope and social support were hypothesized to serve as resilience factors against distress in mothers of children with chronic physical conditions. Relationships among these variables were tested. Ss were 111 mothers of 5 to 18-yr-old children who had cerebral palsy, spina bifida, or insulin-dependent diabetes mellitus. Tests used included the Hope Scale, Social Support Questionnaire-6, Brief Symptom Inventory, and Parents of Children With Disabilities Inventory. There were no differences in distress among mothers raising children with different conditions. Both hope and social support were associated negatively and uniquely with distress in these mothers. Perceptions of hope moderated the relationship between disability-related stress and maladjustment, suggesting a buffering effect when stress is high. However, hope did not appear to be a mediator of the relationship between social support and distress. These findings enhance our conceptual understanding of distress in maternal caregivers of children with a chronic physical condition. They also support improving sense of hope as is done in some problem-solving training programs to enhance coping in distressed individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)