Goal attainment, locus of control, and coping style in adolescent group counseling.

15 high school counselors conducted small group counseling sessions with 218 students. Client characteristics included sex, race, and competence as perceived by the counselor. Multiple measures of outcome included goal attainment (Kiresuk-Sherman Goal Attainment Scaling), locus of control (Rotter's Internal–External Locus of Control Scale—I–E), and coping style (Tyler Behavioral Attributes of Psychosocial Competence). Multiple perspectives on outcome were provided by independent student and counselor goal attainment ratings. Students attained both personal and educational goals. Although counselors viewed internal students as achieving more goals, moderate I–E generally predicted goal attainment. Blacks differed from Whites in that externals gained the most goals. "Planfulness" of coping style was related to both student- and counselor-rated goal attainment, and students who attained most goals also responded most "planfully" on the postcounseling assessment of coping style. Results suggest that counseling should include teaching "planful" problem solving, and it should not overemphasize the students' internality. Finally, ways are suggested concerning how counseling approaches might be varied in relation to students' race and existing competencies. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utility of selected MMPI-2 scales in the outcome prediction for patients with chronic back pain.

The predictive utility of selected scales from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher et al, 1989) was examined in relation to a number of physical and psychosocial measures of treatment outcome in patients reporting chronic back pain. MMPI-2 scales assessing manifestations of emotional distress were considered: anxiety (Scale 7 [Pt]: Anxiety [ANX] and Obsessiveness [OBS]), depression (Scale 2 [D]: Depression [DEP]), and somatic discomfort (Scale 1 [Hs]: Lassitude-Malaise [Hy3], Somatic Complaints [Hy4], and Health Concerns [HEA]). The outcome results at 6-month follow-up for 120 patients who participated in a 4-week outpatient multimodal treatment program were examined. Results showed several of the selected scales to be predictive of less improvement, depending on the outcome measures used. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships between home environment and scholastic behavior in a disadvantaged population.

Examined relationships between home environmental factors and measures of scholastic ability and attainment for 60 8–9 yr olds living in a disadvantaged area. Six measures of home environmental process variables were obtained for each S. Six measures of scholastic behavior were also obtained; these were derived from the Stanford-Binet Intelligence Scale, Culture Fair Intelligence Test (Scale 1), Marino Graded Word Reading Scale, Irish Word Recognition Test, and Schonell Mechanical Arithmetic Test (Form B). In a series of multiple regression analyses, each measure of scholastic behavior was regressed on the 6 home measures. Results indicate that home variables were most successful in predicting attainment test scores, somewhat less successful in predicting "culture-dependent" (crystallized) intelligence test scores, and least successful in predicting "culture-fair" (fluid) intelligence test scores. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Goal attainment scaling: Planning and outcome.

T. J. Kiresuk and R. E. Sherman's (1968) goal attainment scaling (GAS) and a non-scaled goal-setting (NGAS) approach were compared in terms of their impact on case planning and treatment outcome. Exp I tested the hypothesis that 9 GAS clinicians would formulate more specific indicators of treatment goal progress and set goals more relevant to identified case needs than would 9 NGAS clinicians, while both groups would be equally adept at identifying case needs. Exp II hypothesized that GAS cases would receive higher scores than NGAS cases on standardized measures of treatment outcome, and that GAS scores would correlate significantly with global measures of improvement. Exp I provided support for the contribution of GAS to greater indicator specificity, but not goal relevance. Exp II indicated that GAS cases were perceived by teachers as showing more change than NGAS cases. Improvement on GAS goals was not related to improvement on global measures of treatment outcome. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Catastrophizing, anxiety and pain during dental hygiene treatment

OBJECTIVES: This study examined the relations between catastrophizing, dental anxiety, and pain during dental hygiene treatment. METHODS: Participants were 78 (32 men, 46 women) consecutive referrals to the Dalhousie University Dental Clinic. All patients were scheduled for a scaling procedure performed by senior dental hygiene students. Following treatment, patients completed the Pain Catastrophizing Scale and the Dental Anxiety Scale - Revised, and were asked to rate the degree of pain they experienced during the scaling procedure. RESULTS: Regression analyses revealed that age and the rumination subscale of the Pain Catastrophizing Scale were significant predictors of pain, even when controlling for gender, and oral hygiene status. CONCLUSIONS: The findings suggest that excessive focus on pain sensations may be one of the mechanisms by which catastrophizing leads to increased pain. The clinical challenges will be to develop cost- and time-effective means of identifying individuals who catastrophize and to implement interventions to reduce their level of distress.     

Changes in perspectives of disability among patients, staff, and relatives during rehabilitation of brain injury.

Studied retrospectively changes in behavioral competency ratings of staff, patients, and relatives over the course of an intensive rehabilitation program for 3 groups of 28 seriously brain-damaged patients (aged 19–44 yrs). Group 1 included patients with perspectives similar to those of their social environment. They had more initial emotional distress and showed nonsignificantly less neuropsychological impairment than did Ss in Groups 2 and 3, who greatly underestimated their impairments compared to staff and relative ratings. Ratings of Group 2 Ss became better aligned with staff members and relatives' perspectives at discharge, while Group 3 showed increased divergence from staff and relative ratings. By discharge, Group 1 had reduced emotional distress, while distress increased for Groups 2 and 3. Alignment among perceived behavioral competency ratings was not related to vocational outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy and psychoanalysis in patient management: results of the Heidelberg Catamnesis Project

In the "Heidelberg Long Term Psychotherapy Follow-up Project", a naturalistic study design, all types of treatment were included that had been performed at the Psychosomatic Clinic of the University of Heidelberg for a certain period (combined inpatient and outpatient individual and group therapy, as well as outpatient dynamic psychotherapies and psychoanalyses). The specific value of this project is due to the fact that--apart from many other, for instance psychological, assessment evaluations--three to five individual therapy goals had been predetermined for each patient before starting the treatment (goal attainment scaling). After the end of therapy and at the time of follow-up (3.5 years later on the average), attainment of these goals was assessed by an independent rater. A total of 208 patients were examined who were evaluated according to their diagnosis (neurotic, functional or psychosomatic disorders) and the kind of treatment. With regard to symptomatology, individual therapy goals, psychological assessment and patient satisfaction, the overall results were good, partly very good, and were almost invariably stable during the long follow-up period. Two particular results are discussed separately: 1. As far as symptomatology was concerned, the group of psychoanalysis patients could not maintain the good outcome at the end of therapy during the long follow-up period. 2. Patients with "psychosomatic disorders" attained remarkably good results, particularly if the treatment had initially been an inpatient setting.     

Development, refinement, and psychometric properties of the Attitudes Toward God Scale (ATGS-9).

Perceived relationships with God can be a source of comfort or struggle. To advance the study of spiritual comfort and struggle, we develop the nine-item Attitudes toward God Scale (ATGS-9), and we describe six studies (2,992 total participants) reporting its development and psychometrics. Exploratory and confirmatory factor analyses identified two factors: (1) Positive Attitudes toward God and (2) Disappointment and Anger with God. Subscale scores showed good estimated internal consistency, 2-week temporal stability, and evidence for construct and discriminant validity. Positive Attitudes toward God correlated with measures of religiosity and conscientiousness. Disappointment and Anger with God correlated with negative religious coping, lower religious participation, more distress, higher neuroticism, and entitlement. These results support the ATGS-9 as a brief measure of attitudes toward God. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality assurance in a psychiatric day clinic. A catamnestic study with goal attainment scaling

PURPOSE: For the second time after 1990, a community mental health service questioned the outcome quality of its day hospital in rehabilitating primarily psychotic patients. METHODS: In addition to the assessment of 66 persons at the beginning and at the end of an average of six months' treatment in the years 1990-95, a psychologist who had not been involved in the treatment interviewed 49 persons one year after discharge with the use of goal attainment scaling in five relevant fields. RESULTS: Due to the economic recession the goal attainment decreased with regard to the job situation in the sense that it was difficult to find unsheltered jobs. By defining the goals in accordance with the needs of the patients, an improvement in the lodging situation was observed. As a result of the first study, quality monitoring led to an improvement of the structures that promote spare time interests. Social contacts and coping with everyday life showed sustainable achievements. CONCLUSIONS: These achievements can be interpreted as a result of the comparably long time of exposure to social learning within the therapeutic milieu of the day hospital. This hypothesis of a positive correlation between the sustainability of the outcome and the length of treatment must be validated by another study.     

Patients with traumatic brain injury referred to a rehabilitation and re-employment programme: social and professional outcome for 508 Finnish patients 5 or more years after injury

We studied influence of age and educational level before injury on the social and vocational outcome among a group of traumatic brain injury (TBI) patients with post-injury problems in their education and employment. Patients with TBI, followed up for at least 5 years, and who were admitted to a rehabilitation and re-employment programme, were selected for evaluation of long-term outcome. We used the Glasgow Coma Scale (GCS) scores at the time of emergency admission to the hospital to measure brain injury severity. Age at the time of TBI and educational status before TBI were correlated with the outcome measures at the end of follow-up separately in each category of brain injury severity. The study was carried out at the Kauniala outpatient neurological clinic, which specializes in brain injuries in Finland; it works closely with the Departments of Neurology and Neurosurgery at the Helsinki University Central Hospital. Main outcome measures were functional outcome measured by the Glasgow Outcome Scale (GOS), the educational level reached, and post-injury occupation, as well as the incapacity for work at the end of follow-up. In the severe category of brain injuries, children 7 years or younger at the time of injury suffered severe disability as measured by the GOS scores more often than did the older age groups (p = 0.010, chi 2). They were less often capable of independent employment (p = 0.011, chi 2) than the children injured at the age of 8-16. Patients with a higher education usually had a better outcome. In the category of mild brain injuries the majority of the patients, regardless of age, recovered well according to the GOS, and were capable of independent employment at the end of follow-up. Our patients were selected from the TBI population as survivors with problems in education and re-employment. Those with severe injury sustained early in life (childhood and early teens) coupled with poor educational attainment had relatively worse social and vocational outcome; better outcomes were enjoyed by those severely injured individuals whose injuries were sustained later (late teens or early adulthood). In the groups of patients with moderate and mild brain injuries such a relationship was not found between age or pre-injury education and outcome.     

Brief-term counseling with sexually abused girls: The impact of sex of counselor on clients' therapeutic involvement, self-concept, and depression.

Two overlapping studies were conducted with sexually abused girls referred to a university outpatient clinic for 6 sessions of psychoeducationally based individual counseling in which participants were alternately assigned to either male or female counselors. Ratings of videotaped segments of 21 girls' in-session behavior revealed no significant effect for sex of counselor, although a significant improvement was found in girls' participation in counseling across the 6 treatment sessions. Results for 30 girls who completed all aspects of the counseling program revealed significant pretreatment–posttreatment improvement in Piers-Harris Children's Self-Concept Scale and Children's Depression Inventory (CDI) scores, including responses to the CDI suicidal ideation item. Again, no significant effect was found for sex of counselors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does arterial recanalization improve outcome in carotid territory stroke?

BACKGROUND AND PURPOSE: We sought to determine whether early (< 8 hours) or delayed (8 to 24 hours) recanalization after stroke may be an independent variable in the improvement of clinical outcome in patients with occlusion of the middle cerebral artery. METHODS: We prospectively studied 77 patients by combined Scandinavian Stroke Scale score at admission, repeated computed tomography and angiography before and after thrombolytic treatment at < 8 hours after stroke onset, and transcranial Doppler ultrasound 24 hours later. We tested an association between clinical and neuroradiological baseline characteristics, recanalization, and outcome as assessed by the modified Rankin Scale 4 weeks after stroke and determined the effect of recanalization on mortality and good outcome (Rankin Scale grades 0 to 3) by multiple logistic regression analyses. RESULTS: Recanalization rates at 8 and 24 hours after stroke correlated with sites of occlusion (middle cerebral artery branch, 73% and 73%, trunk, 27% and 38%, respectively; intracranial internal carotid artery bifurcation, 14% and 14%; P = .002), collaterals (good, 43% and 51%, respectively; scarce, 17% and 19%, respectively; P = .01), and Scandinavian Stroke Scale score at admission (P = .002). Six of 6 patients with delayed recanalization had good outcomes. Recanalization at < 8 hours after symptom onset had no independent predictive value for good outcome (P = .69). Recanalization at 24 hours increased the proportion of good outcomes from 23% to 75% in a subgroup of patients. Recanalization did not independently affect mortality (P > .15). CONCLUSIONS: Even if delayed, arterial recanalization may improve clinical outcome in a subgroup of patients with middle cerebral artery occlusion.     

A systems model for low vision rehabilitation. II. Measurement of vision disabilities

BACKGROUND: This study presents and tests a method of measuring vision disabilities. Based on the model presented in the first paper of this series, cognitive and motor activities ("tasks") are organized in a hierarchy that identifies the tasks' behavioral goals (purposes) and the social objectives the goals serve. Two latent variables important to the definition of vision disability are identified: "value of living independently" and "visual ability for independent living." The basic principles of the Rasch measurement model are reviewed, and Rasch models are used to measure the two variables that define vision disability. The need for rehabilitation to meet each goal is represented by "rehabilitative demand," a mathematical function of the measurements made of the value and difficulty of achieving each goal independently. METHODS: Over 400 patients with low vision rated both the importance and difficulty of independently achieving each of 24 goals. Rasch analysis was used to derive interval measures of the social value of each goal, the value that individual patients placed on each goal relative to the derived social definition of independence, the visual ability required to achieve each goal without help, and the visual ability of individual patients to live independently. A rehabilitative demand function was ascertained from the judgments of 17 AAO Diplomates in Low Vision through triadic comparisons and multidimensional scaling. RESULTS: Self-care had the greatest "social value" for independence; performing music had the least. Recreational reading required the greatest "visual ability" to accomplish independently; self-care required the least. Rehabilitative demand was linear with value and nonmonotonic with difficulty. CONCLUSIONS: Rehabilitative demand, an algorithm for defining vision disability, incorporates interval measures of visual ability and the value of independent living estimated from patient-based assessments, a social scale of the value of activities relative to independent living, and a consensus opinion of low vision experts on the prioritization of the need for rehabilitation.     

Are fluoxetine plasma levels related to outcome in obsessive-compulsive disorder?

OBJECTIVE: In obsessive-compulsive disorder, the relationship between blood levels of serotonin reuptake inhibitors and clinical outcome is unclear. In a multicenter trial, the authors examined the relationship between steady state plasma levels of fluoxetine and norfluoxetine (determined after 7 weeks of treatment), and their sum, and clinical outcome. METHOD: Ratings of symptom severity of obsessive-compulsive disorder (Yale-Brown Obsessive Compulsive Scale scores) were obtained at baseline and after 13 weeks for 200 adult outpatients with moderately severe obsessive-compulsive disorder treated with fluoxetine doses of 20 mg/day (N = 68), 40 mg/day (N = 64), and 60 mg/day (N = 68). RESULTS: Mean plasma levels of fluoxetine and norfluoxetine were statistically significantly higher with higher dose. Statistical analyses revealed no significant relationship for plasma level of either molecule or their sum in predicting endpoint percent change in obsessive-compulsive scores. Plasma levels of patients with a marked response (decrease of 50% or more in obsessive-compulsive score) did not differ significantly from those of nonresponders (less than a 25% decrease in obsessive-compulsive score). No hint was seen of a therapeutic window or of a relationship limited to one gender or within the lowest dose group (20 mg/day). However, since S-norfluoxetine is a much more potent serotonin reuptake inhibitor than R-norfluoxetine, the absence of chiral (stereospecific) assays in this study limits the results. CONCLUSIONS: Steady state plasma levels of fluoxetine and norfluoxetine are not related to clinical outcome in patients with obsessive-compulsive disorder. Individual patients can be told only that the optimum dose of fluoxetine for them will be the dose that produces the largest therapeutic effect with the smallest side effect burden. Future studies should examine the predictive utility of measures of serotonergic neuronal function and, if plasma levels of norfluoxetine are examined, the use of chiral assays.     

Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training.

Elementary school children with mild-to-moderate depressive symptoms were randomly assigned to a control group or an 8-session Primary and Secondary Control Enhancement Training program. The program focused on (a) primary control (changing objective conditions to fit one's wishes; e.g., through activity selection and goal attainment) and (b) secondary control (changing oneself to buffer the impact of objective conditions; e.g., altering depressogenic thinking, practicing mood-enhancing cognitions ) . At immediate posttreatment and 9-month follow-up, the treatment group showed greater reductions than the control group in depressive symptomatology on the Children's Depression Inventory and the Revised Children's Depression Rating Scale, and treated children, more than controls, shifted from above to within the normal range on both measures. Future research is needed to test treatment effects with severely depressed youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Perception of Procedures Questionnaire: psychometric properties of a brief parent report measure of procedural distress

Reported the reliability and validity of the Perception of Procedures Questionnaire (PPQ), a 19-item parent-report measure developed to assess child and parent distress related to lumbar punctures and bone marrow aspirates in the diagnosis and treatment of childhood cancer. PPQ data from 140 mothers and 96 fathers of children and adolescents with leukemia in a first remission were analyzed separately. Factor analyses yielded five factors for mothers and fathers: Parent Satisfaction; Child Distress: During; Child Distress: Before; Parent Distress; and Parent Involvement. Internal consistency (Cronbach's alpha) was high for the total score and the five factor scores as were interrater reliabilities between mothers and fathers. Validity was determined using the Parenting Stress Index-Short Form, the Pediatric Oncology Quality of Life Scale, and parent and nurse ratings during procedures. Factors 2 and 3, assessing child distress, show strong associations with the validation measures and support the distinction between distress before and during procedures. This developing scale is recommended for use in the assessment and evaluation of child and parent procedure-related distress in pediatric oncology.     

Differential effects of experiential and problem-solving interventions in resolving marital conflict.

Compared the relative effectiveness of 2 interventions in the treatment of marital discord: a cognitive-behavioral intervention that focused on teaching problem-solving skills and an experiential intervention that focused on emotional experiences underlying interaction patterns. 45 couples seeking therapy were randomly assigned to 1 of these treatments or to a wait-list control group. Each treatment was administered in 8 sessions by 6 experienced therapists whose interventions were monitored and rated to ensure treatment fidelity. Assessment measures included the Dyadic Adjustment Scale; Couples Therapy Alliance Scale; and tests of emotional style, target complaints, goal attainment, and intimacy. Results indicate that the perceived strength of the working alliance between couples and therapists and of general therapists effectiveness were equivalent across treatment groups and that both treatment groups made significant gains over untreated controls on measures of goal attainment, marital adjustment, intimacy levels, and target complaint reduction. The effects of the emotionally focused treatment were superior to those of the problem-solving treatment on marital adjustment, intimacy, and target complaint level. At follow-up, marital adjustment scores in the emotionally focused group were still significantly higher than those in the problem-solving group. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome of multimodal day treatment for children with severe behavior problems: a five-year follow-up

OBJECTIVE: To evaluate the long-term outcome of a multimodal day treatment program for children with severe behavior problems and to identify factors that may predict a positive outcome. METHOD: Thirty-three children who completed a day treatment program were assessed using a prospective, single-cohort design tested at intake, discharge, and 5-year follow-up. The child's functioning was assessed using the Revised Child Behavior Profile (RCBP), Hare Self-Esteem Scale, Depression Self-Rating Scale, Hopelessness Scale for Children, Index of Peer Relations, and a 5-point ordinal scale for scholastic reintegration. RESULTS: Repeated-measures analyses of variance showed that improvement was maintained on all measures between intake and 5-year follow-up. A stepwise multiple regression showed that 92% of the adjusted variance in the behavioral functioning of the children at 5-year follow-up, as assessed by the RCBP, was explained by parental cooperation, initial RCBP total and externalizing scores, and history of problem pregnancy. CONCLUSIONS: Children who were admitted to a day treatment setting appear to function well globally, even 5 years after discharge. Parental cooperation was the most important variable in predicting positive outcome.     

Schematic change as a result of an intensive group-therapy day-treatment programs.

Treatment effects of a 12-wk day-treatment program were explored on measures of psychiatric distress (Brief Symptom Inventory) and maladaptive schemas (Schema Questionnaire Short Form; J. Young, 1990). 84 program completers (aged 22–57 yrs) showed significant pre–post change in psychiatric distress and on 3 of 15 schema: vulnerability to harm, social alienation, and defectiveness. Other schema did not change over the 12 wks. 15 waiting-list controls demonstrated no improvement in either distress level or in any of the 15 schema while waiting to be admitted to the program. Only 1 of the 15 schema, abandonment, predicted treatment outcome on changes in psychiatric distress level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping style, perceived uncertainty in illness, and distress in individuals with Parkinson's disease and their caregivers.

Examined the relationship of coping style and illness uncertainty to psychological distress in individuals with Parkinson's disease (PD) and their primary caregivers. Design: Correlational methods, within-group theory-driven hierarchical regression analyses, and transactional analyses. Ss were 44 dyads composed of individuals with PD and their caregivers. Main Outcome Measures: Hoehn and Yahr Clinical Disability Rating Scale, Instrumental Activities of Daily Living Scale, Symptom Distress Checklist-90—Revised, Mischel Uncertainty in Illness Scale-Community Form, and Revised Ways of Coping Checklist. Results: Emotion-focused coping was associated with higher levels of distress for persons with PD, whereas both emotion-focused coping and perceived uncertainty were associated with distress for the caregivers. Transactional analyses between patients and caregivers indicated that higher levels of patient problem-focused coping and perceived uncertainty in illness were associated with increased problems in caregiver distress. Adjustment to PD is influenced by several patient and caregiver variables. The results warrant consideration of a variety of clinical interventions involving patient and caregiver education about the disease and methods for managing the associated symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)