21 resultados para mastery

em BORIS: Bern Open Repository and Information System - Berna - Suiça


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Background: A growing body of literature suggests that caregiving burden is associated with impaired immune system functioning, which may contribute to elevated morbidity and mortality risk among dementia caregivers. However, potential mechanisms linking these relationships are not well understood. The purpose of this study was to investigate whether stress-related experience of depressive symptoms and reductions in personal mastery were related to alterations in ss2-adrenergic receptor sensitivity.Methods: Spousal Alzheimer's caregivers (N = 106) completed measures assessing the extent to which they felt overloaded by their caregiving responsibilities, experienced depressive symptoms, and believed their life circumstances were under their control. We hypothesized that caregivers reporting elevated stress would report increased depressive symptoms and reduced mastery, which in turn would be associated with reduced ss2- adrenergic receptor sensitivity on peripheral blood mononuclear cells (PBMC), as assessed by in vitro isoproterenol stimulation.Results: Regression analyses indicated that overload was negatively associated with mastery (beta = -0.36, p = 0.001) and receptor sensitivity (beta = -0.24, p = 0.030), whereas mastery was positively associated with receptor sensitivity (beta = 0.29, p = 0.005). Finally, the relationship between overload and receptor sensitivity diminshed upon simultaneous entry of mastery. Sobel's test confirmed that mastery significantly mediated some of the relationship between overload and receptor sensitivity (z = -2.02, p = 0.044).Conclusions: These results suggest that a reduced sense of mastery may help explain the association between caregiving burden and reduced immune cell ss2-receptor sensitivity.

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This study examined the protective effects of personal mastery on the relations between both objective and subjective stress and psychiatric morbidity in 79 spousal Alzheimer caregivers. Results indicated that with low mastery, the relations between patient problem behaviors and caregiver psychiatric symptoms was significant (t[71] = 2.03; p = 0.046). However, with high mastery, no significant association was found (t[71] = -0.76; p = 0.452). Similarly, the relations between role overload and psychiatric morbidity was significant when mastery was low (t[71] = 2.22; p = 0.029), but not high (t[71] = -1.49; p = 0.140). These results suggest that caregivers with a greater sense of personal mastery may be protected from the negative effects of caregiver stress.

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OBJECTIVE: This study tested whether feelings of personal control over one's life circumstances (i.e., personal mastery) would attenuate the relations between stress (i.e., negative life events and caregiving distress) and Plasminogen Activator Inhibitor (PAI)-1 antigen, an inhibitor of fibrinolysis implicated in the development of cardiovascular disease. DESIGN: Seventy-one spousal dementia caregivers were assessed for plasma levels of PAI-1 antigen, negative life events, caregiver distress, and feelings of personal mastery. Regression analysis was used to determine if personal mastery moderated the relations between stress (i.e., life stress and caregiving distress) and PAI-1 antigen levels. MAIN OUTCOME MEASURE: Plasminogen activator inhibitor (PAI)-1 antigen in plasma. RESULTS: After controlling for other factors associated with PAI-1 antigen levels, negative life events were positively associated with plasma PAI-1 antigen concentrations in participants low in personal mastery (beta = .31; p = .050) but not in individuals high in personal mastery (beta = .22; p = .184). The moderating effect of mastery on the relations between caregiving distress and PAI-1 antigen did not reach statistical significance (p = .091). CONCLUSIONS: These data suggest that mastery may protect individuals from some of the alterations in hemostatic factors that have been linked to cardiovascular risk.

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OBJECTIVES: Spousal caregivers of Alzheimer's disease patients are at increased risk for cardiovascular disease, possibly via sympathetic response to stressors and subsequent catecholamine surge. Personal mastery (i.e., belief that one can manage life's obstacles) may decrease psychological and physiological response to stressors. This study examines the relationship between mastery and sympathetic arousal in elderly caregivers, as measured by norepinephrine (NE) reactivity to an acute psychological stressor. DESIGN: Cross-sectional. SETTING: Data were collected by a research nurse in each caregiver's home. PARTICIPANTS: Sixty-nine elderly spousal Alzheimer caregivers (mean age: 72.8 years) who were not taking beta-blocking medication. INTERVENTION: After assessment for mastery and objective caregiving stressors, caregivers underwent an experimental speech task designed to induce sympathetic arousal. MEASUREMENTS: Mastery was assessed using Pearlin's Personal Mastery scale and Alzheimer patient functioning was assessed using the Clinical Dementia Rating Scale, Problem Behaviors Scale, and Activities of Daily Living Scale. Plasma NE assays were conducted using pre- and postspeech blood draws. RESULTS: Multiple regression analyses revealed that mastery was significantly and negatively associated with NE reactivity (B = -9.86, t (61) = -2.03, p = 0.046) independent of factors theoretically and empirically linked to NE reactivity. CONCLUSIONS: Caregivers with higher mastery had less NE reactivity to the stressor task. Mastery may exert a protective influence that mitigates the physiological effects of acute stress, and may be an important target for psychosocial interventions in order to reduce sympathetic arousal and cardiovascular stress among dementia caregivers.

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OBJECTIVE: A substantial proportion of chronically-stressed spousal dementia caregivers report fatigue. The objective of this study was to examine whether personal mastery moderates the relationship between caregiving status (caregiver/non-caregiver) and multiple dimensions of fatigue. METHODS: Seventy-three elderly Alzheimer's caregivers and 41 elderly non-caregivers completed the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) and questionnaires assessing mastery. RESULTS: Regression analyses indicated that global fatigue was significantly higher for caregivers (M = 38.0 +/- 21.0) compared to non-caregivers (M = 18.2 +/- 10.4). However, personal mastery moderated the relation between caregiving status and global fatigue (t = -2.03, df = 107, p = 0.045), such that for those with low mastery, caregivers' fatigue scores were 18.1 points higher than non-caregivers, and for those with high mastery, this difference was only 7.5 points. For specific dimensions of fatigue, mastery moderated the relations between caregiving status and both emotional (t = -2.01, df = 107, p = 0.047) and physical (t = -2.51, df = 107, p = 0.014) fatigue. Specifically, association between caregiving status and emotional fatigue was greater when mastery was low than when mastery was high. Caregiving status was significantly associated with physical fatigue when mastery was low, but not when mastery was high. Significant main effects were found between mastery and general fatigue and vigor. CONCLUSION: Given the proportion of fatigued caregivers and the impact fatigue has on health; these findings provide important information regarding mastery's relationship with fatigue and may inform interventions aiming to alleviate fatigue in caregivers. Copyright (c) 2009 John Wiley ; Sons, Ltd.

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In vielen Situationen bekommen Personen beim Lernen neuer Aufgaben in einer ersten Phase Feedback, doch in einer zweiten Phase arbeiten sie ohne Feedback. Bislang gibt es einige Befunde zu der Auswirkung eines Feedbacks auf die unmittelbare Leistung, nicht jedoch auf die mittelfristige Leistung in einer Phase ohne Feedback. Es ist zu erwarten, dass die Form der Leistungsmotivation hier eine entscheidende Rolle spielt. Für Personen, die das Ziel haben, besser zu sein als andere, kann ein negatives Feedback eine Bedrohung des Selbstwertes darstellen und daher demotivieren. Mittelfristig sollte jedoch die Bedrohung des Selbstwertes abnehmen. Daher ist zu erwarten, dass Feedback mittelfristig die Leistung steigert. Für Personen, die das Ziel haben, ihre Kenntnisse zu verbessern, stellt ein negatives Feedback keine Bedrohung des Selbstwertes da. Daher sollte sich Feedback anfänglich positiv auf die Leistung auswirken. Diese Personen lieben jedoch das Gefühl, sich Kenntnisse selbst zu erarbeitet zu haben. Feedback verdirbt den Spass am selbstständigen Explorieren und Lösungen finden. Feedback sollte daher - nach einer anfänglichen Leistungssteigerung- mittelfristig zu einer Verringerung der Leistung führen. Wir zeigen in einer Studie in der Tangram Puzzles gelöst wurden, dass beide Prozesse stattfinden.

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Problemstellung: Patienten mit (komorbider) generalisierter Angststörung (GAS) werden oftmals als ausschließlich depressive Patienten fehlinterpretiert. Da GAS-Patienten relativ gut auf die medikamentöse Depressions- Behandlung ansprechen, wird diese Fehlinterpretation in der Praxis oftmals nicht erkannt. Für die Psychotherapie kann sich die nicht erkannte GAS-Problematik jedoch ungünstig auswirken, so dass die Patienten ein suboptimales psychotherapeutisches Angebot erhalten (wie beispielsweise suboptimale Psychoedukation, Verstärkung der Nervosität durch den schnellen Aufbau „angenehmer“ Tätigkeiten). GAS-spezifische Aspekte, wie das Erkennen von Sorgenketten werden dadurch von Therapeuten oftmals übersehen oder falsch interpretiert (z. B. Fehlinterpretation der Sorgenketten als „ressourcenorientierte“ Ziele oder „positive“ Reframings). Ziele des Workshops: Einführung in die deutsche Adaption des Manuals Mastery your Anxiety and Worry (MAW) nach Zinbarg, Craske & Barlow (2006) mittels Therapiemanual und Videobeispielen GAS-spezifische Interventionen wie GAS-Psychoedukation, Sorgentagebuch oder Imagery exposure kennen Ressourcen- und problemorientierte Fallkonzeption im Rahmen der generalisierten Angststörung kennen Individualisierung im Rahmen des MAW-Manuals

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This study aimed to determine if Alzheimer caregivers have increased allostatic load compared to non-caregivers. Potential psychological moderators (mastery, depression, and role overload) of the relationship between caregiving status and allostatic load were also explored. Eighty-seven caregivers and 43 non-caregivers underwent biological assessment of allostatic load and psychological assessments. Caregivers had significantly higher allostatic load compared to non-caregivers ( p < .05). Mastery, but not depression or overload, moderated the relationship between caregiving status and allostatic load. In conclusion, allostatic load may represent a link explaining how stress translates to downstream pathology, but more work is necessary to understand the role of psychological factors.

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Caring for a spouse with Alzheimer's disease (AD) is associated with overall health decline and impaired cardiovascular functioning. This morbidity may be related to the effects of caregiving stress and impaired coping on beta(2)-adrenergic receptors, which mediate hemodynamic and vascular responses and are important for peripheral blood mononuclear cell (PBMC) trafficking and cytokine production. This study investigated the longitudinal relationship between stress, personal mastery, and beta(2)-adrenergic receptor sensitivity assessed in vitro on PBMC. Over a 5-year study, 115 spousal AD caregivers completed annual assessments of caregiving stress, mastery, and PBMC beta(2)-adrenergic receptor sensitivity, as assessed by in vitro isoproterenol stimulation. Heightened caregiving stress was associated with significantly decreased receptor sensitivity, whereas greater sense of personal mastery was associated with significantly increased receptor sensitivity. These results suggest that increased stress may be associated with a desensitization of beta(2)-receptors, which may contribute to the development of illness among caregivers. However, increased mastery is associated with increased receptor sensitivity, and may therefore serve as a resource factor for improved health in this population.

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Da eine leistungssportliche Fussball Karriere mit Blick auf eine existenzsichernde Zukunft ein risikoreiches Unterfangen ist, absolvieren die meisten Schweizer Fussball-Juniorennationalspieler auch eine Berufsausbildung. Daher stellt sich die Frage, ob und unter welchen Bedingungen eine erfolgreiche Fussballkarriere möglich ist, wenn parallel ein Berufsabschluss angestrebt wird. Nach Mayer (2009) vollzieht sich der menschliche Lebensverlauf in verschiedenen Lebensbereichen, die sich gegenseitig beeinflussen. Um dieser Interdependenz gerecht zu werden, wurde von einem personorientierten Ansatz ausgegangen, der Entwicklungsprozesse möglichst ganzheitlich zu erfassen vermag. 159 ehemalige Schweizer Juniorennationalspieler wurden zu ihrer Karriere retrospektiv befragt und die Daten mittels LICUR-Methode (Bergman, Magnusson, & El-Khouri, 2003) ausgewertet. Dabei wurden auf der Grundlage relevanter Variablen der sportlichen Laufbahn, der beruflichen Ausbildung und der familialen Unterstützung spezifische Muster identifiziert und diese anschließend mit einem Leistungskriterium im Höchstleistungsalter verglichen. Dadurch konnten erfolgsversprechende Entwicklungsmuster aufgedeckt werden. Es zeigt sich, dass der kritische Übergang von der Development zur Mastery Phase (Salmela, 1994) insgesamt durch Kontinuität geprägt ist. Die erfolgreichsten Muster charakterisieren sich durch eine überdurchschnittlich hohe Unterstützung durch die Familie bei gleichzeitig überdurchschnittlich professionellen Förderbedingungen im Club.

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Understanding the dropout rates of efficacious forms of psychotherapy for patients with binge eating disorder (BED) is an unsolved problem within this increasing population. Up until now the role of psychotherapy process characteristics as predictors of premature termination has not been investigated in the BED literature. Within a randomized controlled trial (N=78) we investigated the degree to which early psychological process characteristics, such as components of the therapeutic relationship and the experiences of mastery and motivational clarification, predicted premature termination of treatment. We statistically controlled for the influences of covariates such as rapid response of treatment, treatment group, body mass index, Axis II disorder, and patients' preexisting generalized self-efficacy at baseline. Patients' postsession reports from Sessions 1 to 5 indicated that low self-esteem in-session experiences was a stable predictor of premature termination. Its predictive value persisted after controlling for the above-mentioned covariates. Exploratory analyses further revealed low self-esteem experiences, low global alliance, and low mastery and clarification experiences as predictors in those patients who explicitly specified discontentment with therapy as reason for premature termination. These results indicate that patients' self-esteem experiences may not be an epiphenomenon of their specific psychopathology but may represent general mechanisms on which remaining or withdrawing from psychotherapeutic treatment depends. Early psychotherapy process characteristics should therefore be considered in training and evaluation of psychotherapists carrying through BED treatments.

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Theoretischer Hintergrund: Im Therapieprozess findet eine ständige reziproke Einflussnahme zwischen Patient und Therapeut statt (Strong & Claiborn, 1982). Ein hypothetisches Ziel des Patienten ist es dabei, einen bestimmten Eindruck von sich zu vermitteln. Dieses Ziel ist insbesondere im Erstkontakt wichtig. Während sich die Forschung v.a. mit den Beeinflussungsstrategien des Therapeuten beschäftigte, existieren bisher kaum Studien, die das Beeinflussungsverhalten des Patienten untersuchten. Diese Studie soll deshalb eine Übersicht über die häufigsten Beeinflussungstaktiken bieten, die Patienten im Erstgespräch zeigen. Methoden: 12 Beeinflussungsstrategien wurden aufgrund der Erfahrung von praktizierenden Psychotherapeuten sowie verschiedener theoretischer Konzeptionen der Therapiebeziehung formuliert. Die Taktiken lauten: Gute Stimmung erzeugen, positive Rückmeldungen geben, negative Rückmeldungen geben, inhaltliche Vermeidung, emotionale Vermeidung, Agenda setting, Therapeuten zu Stellungnahme bewegen, negative Berichte über Dritte, Plausibilitätsfallen, Leidensdruck verdeutlichen, Self-promotion und Psychologisieren. Die Daten wurden von vier geschulten Beurteilern analysiert. Ergebnisse: Untersucht wurden Video-Aufzeichnungen von 60 Erstgesprächen, die an der psychotherapeutischen Praxisstelle der Universität Bern durchgeführt wurden. Ergebnisse zur Häufigkeit der verschiedenen Beeinflussungstaktiken sowie deren Zusammenhang mit verschiedenen Patientenmerkmalen werden präsentiert. Diskussion: Die Resultate werden vor dem Hintergrund verschiedener Theorien der Therapiebeziehung (z.B. Interpersonale Theorie und Psychotherapie, Control Mastery Theorie, Plananalyse) diskutiert. In der Praxis kann die Kenntnis der Beeinflussungstaktiken insbesondere unerfahrenen Psychotherapeuten helfen, sich auf die Interaktion mit verschiedenen Patienten einzustellen und die Therapiebeziehung je nach Anforderungen individuell zu gestalten.

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Contemporary models of self-regulated learning emphasize the role of distal motivational factors for student's achievement, on the one side, and the proximal role of metacognitive monitoring and control for learning and test outcomes, on the other side. In the present study, two larger samples of elementary school children (9- and 11-year-olds) were included and their mastery-oriented motivation, metacognitive monitoring and control skills were integrated into structural equation models testing and comparing the relative impact of these different constituents for self-regulated learning. For one, results indicate that the factorial structure of monitoring, control and mastery motivation was invariant across the two age groups. Of specific interest was the finding that there were age-dependent structural links between monitoring, control, and test performance (closer links in the older compared to the younger children), with high confidence yielding a direct and positive effect on test performance and a direct and negative effect on adequate control behavior in the achievement test. Mastery-oriented motivation was not found to be substantially associated with monitoring (confidence), control (detection and correction of errors), or test performance underlining the importance of proximal, metacognitive factors for test performance in elementary school children.

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Traumatic brain injuries (TBIs) occur frequently in childhood and entail broad cognitive deficits, particularly in the domain of executive functions (EF). Concerning mild TBI (mTBI), only little empirical evidence is available on acute and postacute performance in EF. Given that EF are linked to school adaptation and achievement, even subtle deficits in performance may affect children's academic careers. The present study assessed performance in the EF components of inhibition, working memory (WM), and switching in children after mTBI. Regarding both acute and postacute consequences, performance trajectories were measured in 13 patients aged between 5 and 10 years and 13 controls who were closely matched in terms of sex, age, and education. Performance in the EF components of inhibition, switching, and WM was assessed in a short-term longitudinal design at 2, 6, and 12 weeks after the mTBI. Results indicate subtle deficits after mTBI, which became apparent in the longitudinal trajectory in the EF components of switching and WM. Compared with controls, children who sustained mTBI displayed an inferior performance enhancement across testing sessions in the first 6 weeks after the injury in switching and WM, resulting in a delayed deficit in the EF component of WM 12 weeks after the injury. Results are interpreted as mTBI-related deficits that become evident in terms of an inability to profit from previous learning opportunities, a finding that is potentially important for children's mastery of their daily lives.

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Objective: Processes occurring in the course of psychotherapy are characterized by the simple fact that they unfold in time and that the multiple factors engaged in change processes vary highly between individuals (idiographic phenomena). Previous research, however, has neglected the temporal perspective by its traditional focus on static phenomena, which were mainly assessed at the group level (nomothetic phenomena). To support a temporal approach, the authors introduce time-series panel analysis (TSPA), a statistical methodology explicitly focusing on the quantification of temporal, session-to-session aspects of change in psychotherapy. TSPA-models are initially built at the level of individuals and are subsequently aggregated at the group level, thus allowing the exploration of prototypical models. Method: TSPA is based on vector auto-regression (VAR), an extension of univariate auto-regression models to multivariate time-series data. The application of TSPA is demonstrated in a sample of 87 outpatient psychotherapy patients who were monitored by postsession questionnaires. Prototypical mechanisms of change were derived from the aggregation of individual multivariate models of psychotherapy process. In a 2nd step, the associations between mechanisms of change (TSPA) and pre- to postsymptom change were explored. Results: TSPA allowed a prototypical process pattern to be identified, where patient's alliance and self-efficacy were linked by a temporal feedback-loop. Furthermore, therapist's stability over time in both mastery and clarification interventions was positively associated with better outcomes. Conclusions: TSPA is a statistical tool that sheds new light on temporal mechanisms of change. Through this approach, clinicians may gain insight into prototypical patterns of change in psychotherapy.