Worry, problem elaboration and suppression of imagery: the role of concreteness

Both lay concept and scientific theory claim that worry may be helpful for defining and analyzing problems. Recent studies, however, indicate that worrisome problem elaborations are less concrete than worry-free problem elaborations. This challenges the problem solving view of worry because abstract problem analyses are unlikely to lead to concrete problem solutions. Instead the findings support the avoidance theory of worry which claims that worry suppresses aversive imagery. Following research findings in the dual-coding framework [Paivio, A. (1971). Imagery and verbal processes. New York: Holt, Rhinehart and Winston; Paivio, A. (1986). Mental representations: a dual coding approach. New York: Oxford University Press.], the present article proposes that reduced concreteness may play a central role in the understanding of worry. First, reduced concreteness can explain how worry reduces imagery. Second, it offers an explanation why worrisome problem analyses are unlikely to arrive at solutions. Third, it provides a key for the understanding of worry maintenance

Assessing measurement invariance in questionnaires within latent trait models using item response theory

Using questionnaires or inventories. researchers often perform mean comparisons between different populations (e.g .• males vs. females) in order to draw inferences about actual differences in the constructs being measured. However, such comparisons are not meaningful unless the assessments obtained in each of the populations are conmesurable or invariant across populations. Most researchers simply assume that measuremnt invariance holds. However, the extent to which this assumption is a reasonable one for specific measures and specific populations should be tested empirically. Using item response theory, the present study shows how gender measurement invariance can be determined when. as is most common, a psychological construct is assessed by means of a questionnaire or inventory composed of categorical items. To illustrate our method, the Positive Problem Orientation scale of the Social Problem-Solving Inventory-Revised (D' Zurilla. Nezu & Maydeu-Olivares, 1996) was assessed and found to be reasonably gender invariant. whereas the Negative Problem Orientation scale was not

Development and Validation of a Modified Multiple Errands Test for Adults with Intellectual Disabilities

Background: The aims of the current study were to adapt a version of the MET for people with intellectual disabilities (IDs) and assess its ecological and construct validity. Material and Methods: Using a correlational design, 40 participants with IDs were invited to complete a battery of neuropsychological assessments and the modified Multiple Errands Test for Intellectual Disabilities (mMET-IDs). Results: The ability to successfully complete tasks on the mMET-IDs correlated significantly with measures of the Supervisory Attentional System, namely, the Tower of London Test and the Six Parts Test. However, performance on the mMET-IDs and the Six Parts Test could be accounted for by Verbal IQ and receptive vocabulary. The mMET-IDs failed to correlate with the DEX-IR. Conclusions: The mMET-IDs can be successfully used to assess some aspects of the Supervisory Attentional System in people with IDs. Further development is needed, however, to improve the ecological validity of the mMET-IDs

Comparison of four methods for assessing the importance of attitudinal beliefs: An international Delphi study in intensive care settings

Objectives: Behaviour change interventions often target ‘important’ beliefs. The literature proposes four methods for assessing importance of attitudinal beliefs: elicitation frequency, importance ratings, and strength of prediction (bivariate and multivariate). We tested congruence between these methods in a Delphi study about selective decontamination of the digestive tract (SDD). SDD improves infection rates among critically ill patients, yet uptake in intensive care units is low internationally. Methods: A Delphi study involved three iterations (‘rounds’). Participants were 105 intensive care clinicians in the United Kingdom, Canada, and Australia/New Zealand. In Round 1, semi‐structured interviews were conducted to elicit beliefs about delivering SDD. In Rounds 2 and 3, participants completed questionnaires, rating agreement and importance for each belief‐statement (9‐point Likert scales). Belief importance was assessed using elicitation frequency, mean importance ratings, and prediction of global attitude (Pearson's correlations; beta‐weights). Correlations between indices were computed. Results: Participants generated 14 attitudinal beliefs. Indices had adequate variation (frequencies: 4–94, mean importance ratings: 4.93–8.00, Pearson's correlations: ±0.09 to ±0.54, beta‐weights: ±0.01 to ±0.30). SDD increases antibiotic resistance was the most important belief according to three methods and was ranked second by beta‐weights (behind Overall, SDD benefits patients to whom it is delivered). Spearman's correlations were significant for importance ratings with frequencies and correlations. However, other indices were unrelated. The top four beliefs differed according to the measure used. Conclusions: Results provided evidence of congruence across three methods for assessing belief importance. Beta‐weights were unrelated to other indices, suggesting that they may not be appropriate as the sole method

Predicting outcome of internet-based treatment for depressive symptoms.

In this study we explored predictors and moderators of response to Internet-based cognitive behavioral therapy (CBT) and Internet-based problem-solving therapy (PST) for depressive symptoms. The sample consisted of 263 participants with moderate to severe depressive symptoms. Of those, 88 were randomized to CBT, 88 to PST and 87 to a waiting list control condition. Outcomes were improvement and clinically significant change in depressive symptoms after 8 weeks. Higher baseline depression and higher education predicted improvement, while higher education, less avoidance behavior and decreased rational problem-solving skills predicted clinically significant change across all groups. No variables were found that differentially predicted outcome between Internet-based CBT and Internet-based PST. More research is needed with sufficient power to investigate predictors and moderators of response to reveal for whom Internet-based therapy is best suited. © 2013 Copyright Society for Psychotherapy Research

The effectiveness of adding cognitive behavioural therapy aimed at changing lifestyle to managed diabetes care for patients with type 2 diabetes: design of a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>In patients with type 2 diabetes, the risk for cardiovascular disease is substantial. To achieve a more favourable risk profile, lifestyle changes on diet, physical activity and smoking status are needed. This will involve changes in behaviour, which is difficult to achieve. Cognitive behavioural therapies focussing on self-management have been shown to be effective. We have developed an intervention combining techniques of Motivational Interviewing (MI) and Problem Solving Treatment (PST). The aim of our study is to investigate if adding a combined behavioural intervention to managed care, is effective in achieving changes in lifestyle and cardiovascular risk profile.</p> <p>Methods</p> <p>Patients with type 2 diabetes will be selected from general practices (n = 13), who are participating in a managed diabetes care system. Patients will be randomised into an intervention group receiving cognitive behaviour therapy (CBT) in addition to managed care, and a control group that will receive managed care only. The CBT consists of three to six individual sessions of 30 minutes to increase the patient's motivation, by using principles of MI, and ability to change their lifestyle, by using PST. The first session will start with a risk assessment of diabetes complications that will be used to focus the intervention.</p> <p>The primary outcome measure is the difference between intervention and control group in change in cardiovascular risk score. For this purpose blood pressure, HbA_1c, total and HDL-cholesterol and smoking status will be assessed. Secondary outcome measures are quality of life, patient satisfaction, physical activity, eating behaviour, smoking status, depression and determinants of behaviour change. Differences between changes in the two groups will be analysed according to the intention-to-treat principle, with 95% confidence intervals. The power calculation is based on the risk for cardiovascular disease and we calculated that 97 patients should be included in every group.</p> <p>Discussion</p> <p>Cognitive behavioural therapy may improve self-management and thus strengthen managed diabetes care. This should result in changes in lifestyle and cardiovascular risk profile. In addition, we also expect an improvement of quality of life and patient satisfaction.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN12666286</p

Breast compression – An exploration of problem solving and decision-making in mammography

Objective: Breast compression decreases radiation dose and reduces potential for motion and geometric unsharpness, yet there is variability in applied compression force within and between some centres. This article explores the problem solving process applied to the application of breast compression force from the mammography practitioners' perspective. Methods: A qualitative analysis was undertaken using an existing full data set of transcribed qualitative data collected in a phenomenological study of mammography practitioner values, behaviours and beliefs. The data emerged from focus groups conducted at six NHS breast screening centres in England (participant n = 41), and semi-structured interviews with mammography educators (n = 6). A researcher followed a thematic content analysis process to extract data related to mammography compression problem solving, developing a series of categories, themes and sub-themes. Emerging themes were then peer-validated by two other researchers, and developed into a model of practice. Results: Seven consecutive stages contributed towards compression force problem solving: assessing the request; first impressions; explanations and consent; handling the breast and positioning; applying compression force; final adjustments; feedback. The model captures information gathering, problem framing, problem solving and decision making which inform an ‘ideal’ compression scenario. Behavioural problem solving, heuristics and intuitive decision making are reflected within this model. Conclusion: The application of compression should no longer be considered as one single task within mammography, but is now recognised as a seven stage problem solving continuum. This continuum model is the first to be applied to mammography, and is adaptable and transferable to other radiography practice settings

Routine practice in staffed community accommodation (approved premises) in England and Wales: Quantitative benchmarking from the first year of a longitudinal study

Background: In England and Wales, ‘approved premises’ (AP) offer 24 hour staffed accommodation for high risk offenders most of whom are returning to the community from prison. With a move towards a standardised operating model, it is essential to be able to measure outcomes. Aims: To collate and evaluate ‘benchmarks’ for approved premises. Methods: A cross-sectional, descriptive design was used to establish the impact of existing practice in all four approved premises in Wales. Data on well-being, life satisfaction, attitudes to violence and problem solving abilities were recorded with 114 male residents (of 484), and attitudes to personality disorder and personal wellbeing/burnout with 30 staff (of 86), in both narrative style and according to a number of scales used within criminal justice and healthcare systems. Perceptions of environmental climate were assessed with both groups. Scores were compared with those from reference groups, including prisoners and secure hospital patients. Criminological outcomes (e.g. prison recall) were obtained for all 486 men. Results: Scores on the scales used were broadly comparable to those in relevant reference groups, but some measures showed floor or ceiling effects. Recall rates, whether directly from the premises or after further onward movement, were about 42% overall; comparable to those reported for similar offenders elsewhere. Conclusions: This paper provides a short battery of measurements for use as benchmarks of experience and outcomes in staffed community accommodation for high risk men