Patient-Therapist Convergence in Alliance and Session Progress Ratings as Predictors of Outcome in Psychotherapy for Generalized Anxiety Disorder

The degree to which patients and their therapists align over time on their perceptions of therapeutic processes and intermediary outcomes has generally been regarded as an important element of effective psychotherapy; however, few studies have examined empirically the influence of such dyadic convergences on ultimate treatment outcomes. This study examined (a) whether early treatment convergences in patient-therapist alliance and session progress ratings were associated with subsequent worry and distress reduction (and final posttreatment level) in psychotherapy for generalized anxiety disorder (GAD), and (b) whether treatment type and the initial (session 1) levels of perceived alliance and session progress moderated these associations. Data derived from a clinical trial in which patients with severe GAD were randomly assigned to receive either 15 sessions of cognitive-behavioral therapy (CBT; n = 43) or 4 sessions of motivational interviewing (MI) followed by 11 integrative CBT-MI sessions (n = 42). Patients and therapists rated the alliance and session progress after each session. Patients rated their worry and distress multiple times throughout treatment. Dyadic multilevel modeling revealed, as predicted, that alliance convergence over the first half of therapy was associated with greater subsequent worry (p = .03) and distress (p = .01) reduction. Additionally, the combination of low initial patient-rated alliance and early divergence was associated with the worst trajectory for the distress outcome (p = .04). Unexpectedly, session progress divergence had a near significant association with lower posttreatment worry (p = .05) and was significantly associated with more accelerated subsequent distress reduction (p = .03). Additionally, for patients who perceived their initial progress more positively, whether dyads converged or diverged in early session progress ratings affected the trajectories (though not the ultimate amount) of distress change (p = .02). These findings suggest that divergence of early patient-therapist alliance perspectives, especially when coupled with lower initial patient-rated alliance quality, may be an important marker for patient nonresponse and therapist responsiveness (e.g., use of alliance repair strategies). The findings on patient-therapist session progress convergence are less straightforward, though several possible implications are discussed

Hot Swapping Protocol Implementations in the OPNET Modeler Development Environment

This research effort demonstrates hot swapping protocol implementations in OPNET via the building of a dependency injection testing framework. The thesis demonstrates the externalization (compiling as stand-alone code) of OPNET process models, and their inclusion into custom DLL\u27s (Dynamically Linked Libraries). A framework then utilizes these process model DLL\u27s, to specify, or “inject,” process implementations post-compile time into an OPNET simulation. Two separate applications demonstrate this mechanism. The first application is a toolkit that allows for the testing of multiple routing related protocols in various combinations without code re-compilation or scenario re-generation. The toolkit produced similar results as the same simulation generated manually with OPNET. The second application demonstrates the viability of a unit testing mechanism for the externalized process models. The unit testing mechanism was demonstrated by integrating with CxxTest and executing xUnit style test suits

Therapist-Level Moderation of Within- and Between-Therapist Process-Outcome Associations

Objective: Although higher-quality patient-therapist alliance and more positive patient outcome expectation (OE) consistently predict improvement in psychotherapy, most research has failed to capture the inherent nuance in these process-outcome relations by parsing them into within-therapist (i.e., differences between patients treated by the same therapist) and between-therapist (i.e., differences between therapists’ average process/outcome ratings across all patients in their caseloads) components. Moreover, the few studies that have done so have produced mixed results, suggesting the possibility of systematic variability in these associations (i.e., moderators). One potential source of such variability could be providers themselves; that is, different therapists could use these processes to differing therapeutic benefit. In this vein, the present study had three primary aims. First, I tested the alliance- and OE-outcome associations at both the within- and between-therapist levels. Second, I examined whether the within-therapist alliance- and OE-outcome associations varied among therapists. Third, I explored therapist-level moderators (i.e., theoretical orientation, self-perceived alliance- and OE-strategy usage, and self-perceived alliance- and OE-fostering effectiveness) of the within- and between-therapist alliance- and OE-outcome associations. Finally, as an ancillary question, I explored whether the two components of the process-outcomes associations interacted to predict treatment outcomes; namely, does the extent to which patient-level variability in alliance and OE correlates with improvement (within-therapist component) differ as a function of therapists’ general abilities (across all patients) to foster positive alliances and OE (between-therapist component)? Method: Data derived from 212 adult outpatients treated naturalistically by 42 psychotherapists as part of a randomized trial that compared different case assignment methods. Patients completed measures of alliance, OE, and outcome repeatedly throughout treatment, and therapist rated their characteristics at baseline. I used multilevel structural equation models to test the primary and ancillary research questions. Results: Regarding aim 1, higher-quality between-therapist alliance was associated with greater caseload-level improvement (0.62, SD = 0.29; 95% credible interval [CI] = 0.003, 1.10), whereas within-therapist alliance was unrelated to patient-level improvement (0.38, SD = 0.20; 95% CI = -0.07, 0.75). Although between-therapist OE was unrelated to caseload-level improvement (2.64, SD = 1.69; 95% CI = -0.67, 6.20), more optimistic OE was associated with greater patient-level improvement (0.84, SD = 0.35; 95% CI = 0.15, 1.53). Regarding aim 2, both within-therapist process-outcome associations varied significantly among therapists. Regarding aim 3, therapists’ self-perceived alliance-fostering effectiveness moderated the within-therapist alliance-outcome association (-0.76, SD = 0.24; 95% CI = -1.18, -0.28), whereas identification with a cognitive behavioral orientation moderated the between-therapist alliance-outcome association (-0.46, SD = 0.23; 95% CI = -0.96, -0.004). Taken together, the alliance may have stronger within-therapist associations with improvement in the hands of therapists who are humbler in assessing their own alliance-fostering abilities, and stronger between-therapist associations with improvement for therapists who do not identify strongly with a cognitive behavioral orientation. Finally, regarding the ancillary aim, the within- and between-therapist process components did not have a significant interactive effect on treatment outcomes. Conclusions. Results indicate that different therapists use theory-common treatment processes to differing therapeutic benefit, which can inform more personalized clinical practices and trainings

Gonadal hormones, but not sex, affect the acquisition and maintenance of a Go/No-Go odor discrimination task in mice

In mice, olfaction is crucial for identifying social odors (pheromones) that signal the presence of suitable mates. We used a custom-built olfactometer and a thirst-motivated olfactory discrimination Go/No-Go (GNG) task to ask whether discrimination of volatile odors is sexually dimorphic and modulated in mice by adult sex hormones. Males and females gonadectomized prior to training failed to learn even the initial phase of the task, which involved nose poking at a port in one location obtaining water at an adjacent port. Gonadally intact males and females readily learned to seek water when male urine (S+) was present but not when female urine (S−) was present; they also learned the task when non-social odorants (amyl acetate, S+; peppermint, S−) were used. When mice were gonadectomized after training the ability of both sexes to discriminate urinary as well as non-social odors was reduced; however, after receiving testosterone propionate (castrated males) or estradiol benzoate (ovariectomized females), task performance was restored to pre-gonadectomy levels. There were no overall sex differences in performance across gonadal conditions in tests with either set of odors; however, ovariectomized females performed more poorly than castrated males in tests with non-social odors. Our results show that circulating sex hormones enable mice of both sexes to learn a GNG task and that gonadectomy reduces, while hormone replacement restores, their ability to discriminate between odors irrespective of the saliency of the odors used. Thus, gonadal hormones were essential for both learning and maintenance of task performance across sex and odor type.We thank David Giese for help in programming the apparatus used in GNG testing and Alberto Cruz-Martin for comments on an early version of the manuscript. This work was supported by NIDCD grant DC008962 to JAC. (DC008962 - NIDCD grant)Accepted manuscrip

Health professionals' perceptions of cultural influences on stroke experiences and rehabilitation in Kuwait

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2012 Informa UK Ltd.Purpose: The aim of this study was to investigate the perceptions of health professionals who treat stroke patients in Kuwait regarding cultural influences on the experience of stroke and rehabilitation in Kuwait. Health professionals interviewed were from a variety of cultural backgrounds thus providing an opportunity to investigate how they perceived the influence of culture on stroke recovery and rehabilitation in Kuwait. Method: Semi-structured interviews were carried out with 12 health professionals with current/recent stroke rehabilitation experience in Kuwait, followed by thematic analysis of the verbatim transcripts. Results: The health professionals identified several features of the Kuwaiti culture that they believed affected the experiences of stroke patients. These were religious beliefs, family involvement, limited education and public information about stroke, prevailing negative attitudes toward stroke, access to finances for private treatment, social stigma and the public invisibility of disabled people, difficulties identifying meaningful goals for rehabilitation, and an acceptance of dependency linked with the widespread presence of maids and other paid assistants in most Kuwaiti homes. Conclusion: To offer culturally sensitive care, these issues should be taken into account during the rehabilitation of Kuwaiti stroke patients in their home country and elsewhere

Evolution of Protein Expression: New Genes for a New Diet

SummaryA new study identifies gene duplication of a salivary enzyme as a recent adaptation to changes in diet among human populations, highlighting the diverse ways that gene regulation can evolve

Defect Characterization by Spatial Distribution of Ultrasonic Scattered Energy

The ultrasonic pulse echo technique is a highly sensitive nondestructive method for detecting small defects within the bulk of a structure. The technique is capable of reliably finding small volumetric defects when the defect size is approximately 0.030 inches in diameter and the specimen thicknesses are not too great. If the distance between the transducer and the defect is large, greater than 2 near field distances, the minimum value of volumetric flaw sizes that can be reliably detected rises considerably. For 6-8 inch thick plates, it is not too surprising to occasionally miss volumetric defects such as slag inclusions of considerable length

Voyager terminal guidance study Final report

Voyager spacecraft terminal guidance system analysi

Tillage Slows Fecal Bacteria Infiltration through Soil

Bacterial pathogens can degrade ground water quality by infiltrating and eroding from land treated with poultry wastes. The potential for ground water contamination (as well as associated health risks and cost of water treatment) greatly depends on the depth of soil to the water table or bedrock and soil structure. Pathogens must move through the soil profile to contaminate ground water (although sinkholes can provide a direct channel from the soil surface to the water table in karst areas). Deep soils have less potential for contamination than shallow soils. Structureless soils retain fecal bacteria better than well structured soils. Research at UK indicates that surface-applied fecal bacteria, and other contaminants, travel rapidly toward ground water through soil pores in well structured, intact soil. Tillage disrupts pores and channels in the tilled layer, and increases water and bacteria contact with soil. To improve our understanding of bacterial movement, and of the potential for ground water contamination, we decided to examine whether tillage affected fecal coliform transport through intact soil amended with poultry wastes. We used poultry wastes because their disposal is an increasingly important waste management issue in western Kentucky