Does the cognitive interview promote the coherence of narrative accounts in children with and without an intellectual disability?

We examined whether the cognitive interview (CI) procedure enhanced the coherence of narrative accounts provided by children with and without intellectual disabilities (ID), matched on chronological age. Children watched a videotaped magic show; one day later, they were interviewed using the CI or a structured interview (SI). Children interviewed using the CI reported more correct details than those interviewed using the SI. Additionally, children interviewed using the CI reported more contextual background details, more logically ordered sequences, more temporal markers, and fewer inconsistencies in their stories than those interviewed using the SI. However, the CI did not increase the number of story grammar elements compared with the SI. Overall children interviewed with the CI told better stories than those interviewed with the SI. This finding provided further support for the effectiveness of the CI with vulnerable witnesses, particularly children with ID.

Assessing the effectiveness of the cognitive interview for children with severe intellectual disabilities

We examined whether the cognitive interview (CI) procedure increased event recall in children with severe intellectual disabilities (ID) compared with children with no ID. Forty-six children with and without ID watched a videotaped event; they were aged between eight and 11 years. The next day they were individually interviewed using the CI or a structured interview (SI). Interviews consisted of free recall and specific questions, some of which contained leading or misleading information. The leading and misleading questions determined children’s susceptibility to information presented after the event. Overall, children without ID reported more correct information than children with ID. For all children, the CI led to more correct recall than the SI without increases in incorrect details or confabulations. Although the CI did not decrease children’s susceptibility to the misleading questions compared with the SI, children without ID disagreed with more of the misleading suggestions than children with ID. These results suggest that the CI may indeed be a valuable tool to elicit information from very vulnerable witnesses.

The effectiveness of the cognitive interview procedure with child witnesses

Two separate studies examined whether the cognitive interview – an interview with embedded mnemonics –enhanced children’s eyewitness accounts. Study 1 found that modifying a mnemonic from a verbal cue to a drawing did not augment memory but protected against suggestive questions. Study 2 found the interview enhanced the coherency of children’s’ account.

Mental reinstatement of context with child witnesses : does it matter whether context is reinstated 'out loud'?

In this study we examined the impact of two types of mental reinstatement of context instructions in facilitating children's recall of a staged event across two stages of development. Specifically, a 2 times 3 factorial design was utilised incorporating two age groups (6- and 12-year-olds) and three interview conditions (standard recall, mental reinstatement where the child was instructed to reinstate the context 'out loud', and mental reinstatement without the explicit 'out loud' instruction). Overall, mental reinstatement instruction led to more correct and fewer incorrect responses than the standard recall instruction. The effect of mental reinstatement was similar across the age groups and irrespective of whether the child was asked to reinstate 'out loud'. Beneficial effects of the technique, however, were only evident for cued-recall questions as opposed to free-narrative responses. The implications of these findings and directions for future research are discussed.

Does free recall moderate the effect of mental context reinstatement instructions on children's cued recall?

Cognitive Interview instructions increase children's recall of events; one important instruction is the mental reinstatement of context. We examined one factor that may affect mental context reinstatement: whether children had the opportunity to freely recall the event before answering cued recall questions. One hundred and fifty-two children aged 6, 9, or 11 years were interviewed twice about a staged event. The event consisted of an argument between two adults about whose turn it was to show the children a film. One week after the event, some of the children received mental context reinstatement instructions before having their cued recall tested. Some children also received a free recall test immediately before the cued recall test. In the second interview, 2 weeks after the first interview, all children freely recalled the event. The results showed no effects of mental context reinstatement instructions and no moderating effect of free recall on children's cued recall. The implications of these findings and directions for future research are discussed.

Examination of the effect of mental reinstatement of context acress developmental level, retention interval and type of mnemonic instruction

The effect of mental reinstatement of context was examined using a 4*5*2 factorial design incorporating four age groups (6-year-olds, 8-year-olds, 11-year-olds and adults), two retention intervals (1 day and 2 weeks after the stimulus event) and five interview conditions. The interview conditions included; free recall, mental reinstatement-environment (where the setting was reinstated but no event-related detail was provided in the mnemonic instruction), mental reinstatement-event (where specific event-related content was provided), mental reinstatement-combined (a combination of the two above-mentioned methods) and specific questions. Overall, mental reinstatement (irrespective of the type) was found to enhance correct recall performance compared to free recall and (unlike specific questions) it did not lead to greater number of commission errors. Contrary to our initial predictions, however, there was no evidence of any special benefit of mental reinstatement for children and the effect of the technique did not vary consistently as a function of retention interval.

The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment

Previous research has demonstrated a high level of depression in nursing homes. The current study was designed to determine the prevalence of depression, using a structured diagnostic interview, among older people with and without mild-moderate cognitive impairment residing in low-level care facilities. The results demonstrated that, consistent with previous research in nursing homes, 16.9% of older people were diagnosed with major depressive disorder. Less than half of these cases had been detected or treated. Individuals with moderate cognitive impairment were more likely to be depressed, but cognitive impairment did not appear to act as a strong impediment to the detection of depression by general practitioners. A low awareness of their use of antidepressant medications was demonstrated among older people prescribed this treatment, including those with normal cognitive function. Reasons for the poor recognition of depression among older people are discussed.

A controlled trial of internet-based cognitive-behavioural therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist

Background: Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive-behavioural treatment (CBT) is rare. Many Australian GPs are now trained to deliver focused psychological strategies, but in practice this is time consuming and costly.

Objective: To evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by general practitioner (GP)-delivered therapeutic assistance.

Design: Panic Online supported by GP-delivered face-to-face therapy was compared to Panic Online supported by psychologist-delivered email therapy.

Methods: Sixty-five people with a primary diagnosis of PD (78% of whom also had agoraphobia) completed 12 weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 34) or a clinical psychologist (n = 31). The mean duration of PD for participants allocated to these groups was 59 months and 58 months, respectively. Participants completed a clinical diagnostic interview delivered by a psychologist via telephone and questionnaires to assess panic-related symptoms, before and after treatment.

Results: The total attrition rate was 20%, with no group differences in attrition frequency. Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity and quality of life. There were no statistically significant differences in the two treatments on any of these measures, or in the frequency of participants with clinically significant PD at post assessment.

Conclusions: When provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental healthcare successfully.

Motivational interviewing and cognitive behaviour therapy in the treatment of adolescent overweight and obesity : study design and methodology

Background

Despite the high prevalence and negative physical and psychosocial consequences of overweight and obesity in adolescents, very little research has evaluated treatment in this population. Consequently, clinicians working with overweight and obese adolescents have little empirical research on which to base their practise. Cognitive behavioural therapy has demonstrated efficacy in promoting behaviour change in many treatment resistant disorders. Motivational interviewing has been used to increase motivation for change and improve treatment outcomes. In this paper we describe the rationale and design of a randomised controlled trial testing the efficacy of motivational interviewing and cognitive behaviour therapy in the treatment of overweight and obese adolescents.
Methods

Participants took part in a motivational interview or a standard semi-structured assessment interview and were then randomly allocated to a cognitive behavioural intervention or a wait-list control condition. The cognitive behavioural intervention, the CHOOSE HEALTH Program, consisted of 13 individual treatment sessions (12 face-to-face, 1 phone call) followed by 9 maintenance sessions (7 phone calls, 2 face-to-face). Assessments were conducted prior to participation, after the treatment phase and after the maintenance phase of intervention. Improvement in body composition was the primary outcome; secondary outcomes included improved cardiovascular fitness, eating and physical activity habits, family and psychosocial functioning.
Conclusion

Despite the demonstrated effectiveness of motivational interviewing and cognitive behavioural therapy in the long-term management of many treatment resistant disorders, these approaches have been under-utilised in adolescent overweight and obesity treatment. This study provides baseline data and a thorough review of the study design and treatment approach to allow for the assessment of the efficacy of motivational interviewing and cognitive behavioural therapy in the treatment of adolescent overweight and obesity. Data obtained in this study will also provide much needed information about the behavioural and psychosocial factors associated with adolescent overweight and obesity.

Content validity of visual analog scales to assess symptom severity of acute angioedema attacks in adults with hereditary angioedema : an interview study

Background: Hereditary angioedema (HAE) is a rare, debilitating, potentially life-threatening condition characterized by recurrent acute attacks of edema of the skin, face/upper airway, and gastrointestinal and urogenital tracts. During a laryngeal attack, people with HAE may be at risk of suffocation, while other attacks are often associated with intense pain, disfigurement, disability, and/or vomiting. The intensity of some symptoms is known only to the person experiencing them. Thus, interview studies are needed to explore such experience and patient-reported outcome measures (PROMs) are required for systematic assessment of symptoms in the clinical setting and in clinical trials of treatments for acute HAE attacks.

Objective: The aim of this interview study was to assess the content validity and suitability of four visual analog scale (VAS) instruments for use in clinical studies. The VAS instruments were designed to assess symptoms at abdominal, oro-facial-pharyngeal-laryngeal, peripheral, and urogenital attack locations. This is the first known study to report qualitative data about the patient's experience of the rare disorder, HAE.

Methods: Semi-structured exploratory and cognitive debriefing interviews were conducted with 27 adults with a confirmed clinical/laboratory diagnosis of HAE (baseline plasma level of functional plasma protein C1 esterase inhibitor [C1INH] <50% of normal without evidence for acquired angioedema). There were 17 participants from the US and 10 from Italy, with mean age 42.5 (SD 14.5) years, range 18–72 years, mean HAE duration 21.3 (SD 14.1) years, range 1–45 years, 67% female, and 44% VAS-naïve. Experience of acute angioedema attacks was first explored, noting spontaneous mentions by participants of HAE symptomatology. Cognitive debriefing of the VAS instruments was undertaken to assess the suitability, comprehensibility, and relevance of the VAS items. Asymptomatic participants completed the VAS instruments relevant to their angioedema experience, reporting as if they were experiencing an acute angioedema attack at the time. Interviews were conducted in the clinic setting in the US and Italy over an 8-month period.

Results: Participants mentioned spontaneously almost all aspects of acute angioedema attacks covered by the four VAS instruments, thus providing strong support for inclusion of nearly all VAS items, with no important symptoms missing. Predominant symptoms found to be associated with acute angioedema attacks were edema and pain, and there was evidence of varying degrees of disruption to everyday activities supporting the inclusion of an overall severity item reflecting the disabling effects of HAE symptoms. VAS item wording was understood by participants.

Conclusion: This interview study explored and reported the patient experience of HAE attacks. It demonstrated the content validity of the four anatomical location HAE VAS instruments and their suitability for use in clinical trials of recombinant human C1INH (rhC1INH) treatment for ascertaining trial participants' assessments of the severity of acute angioedema symptoms.

The multiple mini-interview (MMI) in medical student selection

An historical survey of medical student selection identified the multiple mini-interview (MMI) as a promising tool for the assessment of non-cognitive qualities. The Deakin MMI was found to be reliable and useful in predicting performance during the medical course when used with other established selection criteria such as GPA.

Examining interview techniques to assist children’s recall of repeated events.

This thesis tested interview techniques expected to assist children reporting on repeated events, such as ongoing abuse. The quality and quantity of information children provided was improved by several techniques that rehearsed children in key cognitive tasks. Developmental trends were found whereby techniques often assisted older children more than younger children.