Managing mental health care wisely: More is not necessarily better.

Responds to comments by W. G. Herron (see record 1992-36554-001) on the article by R. L. Lowman (see record 1991-16482-001) on managed mental health care (MMHC). Lowman maintains that restrictions in outpatient coverage in MMHC were not advocated and contends that MMHC must be subjected to the same scientific scrutiny and cost–benefit analyses as any other intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

More is not better: Two failures of incentive theory.

Conducted 2 nationwide interview surveys of 16–22 yr old civilian males (each sample greater than 850 Ss) to assess the influence of incentives on enlistment in the US Navy. The 1st survey employed 17 different incentives, and the 2nd employed 15. Responses on a 5-point scale for single incentives and sets of 2 and 3 incentives were compared. Comparisons were also made of incentives differing in magnitude: $1,000 vs $3,000; 2 yrs vs 4 yrs of free college after 4 yrs of service; and 10% vs 25% of base pay for exceptional performance. No significant changes were found in disposition to enlist when either the number or the absolute magnitude of incentives was increased, thereby countering the assumption that a larger incentive is better. It is suggested that too large an incentive may even lead to distrust or a perceived threat to freedom. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better.

The efficacy of brief treatments for media-recruited pathological gamblers was tested in a randomized clinical trial design (N = 314). Two self-directed motivational interventions were compared with a 6-week waiting list control and a workbook only control. Brief motivational treatment involved a telephone motivational interview and a mailed self-help workbook. Brief motivational booster treatment involved a telephone motivational interview, a workbook, and 6 booster telephone calls over a 9-month period. Primary outcomes were gambling frequency and dollar losses. As hypothesized, brief and brief booster treatment participants reported less gambling at 6 weeks than those assigned to the control groups. Brief and brief booster treatment participants gambled significantly less often over the first 6 months of the follow-up than workbook only participants. However, the workbook only participants were as likely to have significantly reduced their losses over the year and to have not met criteria for pathological gambling. Contrary to the hypothesis, participants in the brief booster treatment group showed no greater improvement than brief treatment participants. These results provide further support for the value of brief motivational treatments for pathological gambling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bigger is not always better: body image dissatisfaction in breast reduction and breast augmentation patients

This study investigated body image dissatisfaction in breast reduction and breast augmentation patients. Thirty breast reduction and 30 breast augmentation patients completed two body image measures preoperatively. Breast reduction patients reported greater dissatisfaction with their overall body image as compared with breast augmentation patients, part of which can be understood as a function of their increased body weight. When asked specifically about their breasts, reduction patients displayed increased body image dysphoria and maladaptive behavioral change, including embarrassment about their breasts in public areas and social settings and avoidance of physical activity. Results are discussed in the context of ideal body weight cutoffs by third-party payers for reimbursement for breast reduction. Recommendations for reimbursement criteria that de-emphasize the role of body weight are made.     

Thinness is not always fashionable

We discuss in this paper the cases of two patients with pure motor hemiparesis which were secondary to chronic subdural hematoma who evolved satisfactorily only with medical treatment. Of 1,000 consecutive patients with cerebro-vascular pathology admitted in our Neurology Department in the last 5 years, said two patients were the only ones (0.2%) in whom the lacunar syndrome "pure motor hemiparesis" was secondary to a chronic subdural hematoma. Such cases show that a subdural hematoma can manifest itself as a lacunar syndrome and that in selected cases the medical treatment of chronic subdural hematoma can yield goods results.     

The distance to community medical care and the likelihood of hospitalization: is closer always better?

OBJECTIVES: This study examined the influence that distance from residence to the nearest hospital had on the likelihood of hospitalization and mortality. METHODS: Hospitalizations were studied for Maine. New Hampshire, and Vermont during 1989 (adults) and for 1985 through 1989 (children) and for mortality (1989) in Medicare enrollees. RESULTS: After other known predictors of hospitalization (age, sex, bed supply, median household income, rural residence, academic medical center, and presence of nursing home patients) were controlled for, the adjusted rate ratio of medical hospitalization for residents living more than 30 minutes away was 0.85 (95% confidence interval [CI] = 0.82, 0.88) for adults and 0.78 (95% CI = 0.74, 0.81) for children, compared with those living in a zip code with a hospital. Similar effects were seen for the four most common diagnosis-related groups for both adults and children. The likelihood of hospitalization for conditions usually requiring hospitalization and for mortality in the elderly did not differ by distance. CONCLUSIONS: Distance to the hospital exerts an important influence on hospitalization rates that is unlikely to be explained by illness rates.     

All that glitters is not always gold: Medical offset effects and managed behavioral health care.

This article urges caution in using broadly predicted medical offset effects in marketing managed behavioral care services. Three analyses of a health maintenance organization population who were provided managed mental health services showed that the use of simple percentage change in cost and use of hospital care may give deceptively positive results. The use of such methods may eventually undermine rather than support the credibility of managed care contracts for professional psychology. Results are discussed in the context of professional psychology's future role in guiding quality assurance and cost-effectiveness studies in regional, multiprofessional primary practice groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A picture is not always worth a thousand words: Pictures as distractors in reading.

Conducted 2 studies with a total of 32 2nd graders and 66 3rd graders to examine the influence of pictures in the periphery on children's speed and accuracy of reading. In both studies, Ss were required to read sets of words under each of 3 conditions: with no pictures, with related pictures, and with unrelated pictures. The 2 studies differed in the age of the Ss (2nd vs 3rd graders) and in the location of the pictures (behind vs above the words). In both studies, the results consistently show the following: (a) The words were read more slowly whenever pictures were present. (b) Unrelated pictures produced more interference than related pictures. (c) The magnitude of both of these effects was inversely related to reading ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

More may not be better in psychosocial interventions for cancer patients.

Comments on the article by M. H. Antoni et al (see record 2000-14051-003) which tested the effects of a 10-week group cognitive-behavioral stress management intervention among female breast cancer patients. The authors express concern that this profession is offering interventions that patients in need cannot access and studying patients who may not be in particular need of intervention and who therefore fail to demonstrate substantial improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When less is not always more: Stereotype knowledge and reasoning development.

Developmental studies on heuristics and biases have reported controversial findings suggesting that children sometimes reason more logically than do adults. We addressed the controversy by testing the impact of children's knowledge of the heuristic stereotypes that are typically cued in these studies. Five-year-old preschoolers and 8-year-old children were tested with a card game version of the classic base-rate task. Problems were based on stereotypes that were familiar or unfamiliar for preschoolers. We also manipulated whether the cued stereotypical response was consistent (no-conflict problems) or inconsistent (conflict problems) with the correct analytic response that was cued in the problem. Results showed that an age-related performance decrease on the conflict problems was accompanied by an age-related performance increase on the no-conflict problems. These age effects were most pronounced for problems that adopted stereotypes that were unfamiliar for the 5-year-old preschoolers. When preschoolers were familiar with the stereotypes, their performance also started being affected. Findings support the claim that previously reported age-related performance decreases on classic reasoning tasks need to be attributed to the increased need to deal with tempting heuristics and not to a decrease in analytic thinking skills per se. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Summing up evidence: one answer is not always enough

Are meta-analyses the brave new world, or are the critics of such combined analyses right to say that the biases inherent in clinical trials make them uncombinable? Negative trials are often unreported, and hence can be missed by meta-analysts. And how much heterogeneity between trials is acceptable? A recent major criticism is that large randomised trials do not always agree with a prior meta-analysis. Neither individual trials nor meta-analyses, reporting as they do on population effects, tell how to treat the individual patient. Here we take a more rounded approach to meta-analyses, arguing that their strengths outweigh their weaknesses, although the latter must not be brushed aside.     

Restrained eating among adolescents: Dieters are not always bingers and bingers are not always dieters.

This study examined individual differences in the relationships among 3 constructs relevant to restrained eating theory—cognitive restraint (dieting), disinhibition (bingeing), and hunger. Participants were 421 adolescents (158 male, 255 female, and 8 not indicated). Comparisons among subgroups based on scores on the 3 constructs indicated that there were (a) 2 types of frequent dieters—those who follow theoretical predictions and become disinhibited and those who maintain their restraint; (b) 2 types of bingers—those who engage in dieting-induced bingeing and those who are hungry and disinhibited; and (c) 2 types of low-hunger eaters—those who suppress their hunger and those who eat before they experience much hunger. Implications of the results for restrained eating theory are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological care for persons of diverse religions: A collaborative continuum.

The purpose of this paper is to describe to psychologists and other clinicians a continuum of mental health care for persons of diverse religions. The continuum delineates boundaries between clinical care provided by mental health professionals and religious care provided by clergy, as well as describes pathways of collaboration across these boundaries. A prevention science based model of Clergy Outreach and Professional Engagement (COPE) is offered to guide this collaboration. The model describes a continuum that moves from the care already present in religious communities, through professional clinical care provided in response to dysfunction and returns persons to their own spiritual communities. One challenge for clinicians is that in addition to a wide diversity of beliefs and practices across religions, there is great ethnic diversity within religions. These diversities are reflected in varied correlations with mental health outcomes. Therefore, we recommend that clinicians assess religious beliefs and their cultural variations when designing religious inclusive psychotherapy specific to the client. There are ethical concerns as to the place of religion in clinical care. The “Resolution on Religious, Religion-Based and/or Religion-Derived Prejudice” adopted by the American Psychological Association has stated that it is not the role of professional psychologists to be spiritual guides. Through spiritual assessment of clients and strategic collaboration with religious leaders via COPE, mental health professionals can focus their efforts on clinical care that respects and incorporates the religious views of clients and does not attempt to recreate the lived religions of the clients' communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Head Start is not child care.

Comments on S. Scarr's (see record 1997-38813-002) defense of cheap, minimally regulated child care. The author responds to Scarr's comments on Head Start. Scarr dismisses Head Start without acknowledging the comprehensive nature of its intervention in the lives of poor children and their families. Head Start does more than child care aspires to do: Head Start makes sure that poor children get medical and dental care, helps their families gain access to social services, offers volunteer and paid employment to parents, involves parents in governance, serves nutritious meals, provides intellectual stimulation, and above all, helps children develop the social competence necessary to succeed in school. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer brainstorms: More heads are better than one.

Research has consistently found nominal group brainstorming (in which members work separately without communicating) to be superior to brainstorming in which group members interact verbally. This article presents the results of an experiment that found the reverse to be true for computer-mediated electronic brainstorming. In this experiment, 12-member electronically interacting groups generated more ideas than did 12-member nominal groups, and there were no differences between 6-member electronic and 6-member nominal groups. The authors attribute these results to the ability of electronic brainstorming to introduce few process losses (production blocking, evaluation apprehension, and free riding) while enabling process gains (synergy and the avoidance of redundant ideas). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

More science not less clarity: A rejoinder to Richardson.

Responds to comments by F. C. Richardson (see record 1998-12018-003) regarding the present author's rejection of the indeterminate textuality of postmodern thought as self-contradictory (see record 1998-12018-002). The present author considers the possibility of a rational-empiricist explanation of human behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)