Assessment of anxiety sensitivity in depressed, older patients and its relation to hypochondriacal concerns

Anxiety disorders in older adults are often overlooked as part of other mental disorders or as part of medical illnesses. Theoretically, anxiety sensitivity is a common component in anxiety disorders, a personality construct and a fundamental fear. Anxiety sensitivity was assessed in a sample of older adults: 53 depressed, M age = 78.8 years; and 53 healthy controls, M age = 70.9 years. This study examined whether anxiety sensitivity: (1) explained unique variance beyond that explained by trait anxiety, (2) was observed in the depressed group in levels similar to individuals who suffer from non-panic, anxiety disorders, and (3) correlated with current number of medical illnesses, previous number of medical illnesses, and hypochondriasis. The results indicated that anxiety sensitivity: predicted hypochondriasis better than trait anxiety, was present in the depressed group similarly to individuals suffering from non-panic, anxiety disorders, and was strongly associated with hypochondriacal concerns. ^

Evaluating the effectiveness of discrete trial procedures for teaching receptive discrimination to children with autism spectrum disorders

Research has found that children with autism spectrum disorders (ASD) show significant deficits in receptive language skills (Wiesmer, Lord, & Esler, 2010). One of the primary goals of applied behavior analytic intervention is to improve the communication skills of children with autism by teaching receptive discriminations. Both receptive discriminations and receptive language entail matching spoken words with corresponding objects, symbols (e.g., pictures or words), actions, people, and so on (Green, 2001). In order to develop receptive language skills, children with autism often undergo discrimination training within the context of discrete trial training. This training entails teaching the learner how to respond differentially to different stimuli (Green, 2001). It is through discrimination training that individuals with autism learn and develop language (Lovaas, 2003). The present study compares three procedures for teaching receptive discriminations: (1) simple/conditional (Procedure A), (2) conditional only (Procedure B), and (3) conditional discrimination of two target cards (Procedure C). Six children, ranging in age from 2-years-old to 5-years-old, with an autism diagnosis were taught how to receptively discriminate nine sets of stimuli. Results suggest that the extra training steps included in the simple/conditional and conditional only procedures may not be necessary to teach children with autism how to receptively discriminate. For all participants, Procedure C appeared to be the most efficient and effective procedure for teaching young children with autism receptive discriminations. Response maintenance and generalization probes conducted one-month following the end of training indicate that even though Procedure C resulted in less training sessions overall, no one procedure resulted in better maintenance and generalization than the others. In other words, more training sessions, as evident with the simple/conditional and conditional only procedures, did not facilitate participants’ ability to accurately respond or generalize one-month following training. The present study contributes to the literature on what is the most efficient and effective way to teach receptive discrimination during discrete trial training to children with ASD. These findings are critical as research shows that receptive language skills are predictive of better outcomes and adaptive behaviors in the future. ^

Evaluation of a six-week professional education curriculum designed to retain registered psychiatric nurses

During the past few years there has been a drastic shortage of registered nurses in the field. The shortage appears to have affected the field of psychiatric mental health nursing most intensely. The psychiatric nursing shortage is a multifaceted problem grounded in decreasing federal funds for advanced clinical training, inadequate undergraduate psychiatric experiences, lack of a well prepared articulate role model, the integrated curriculum and the confusion and blurring associated with the roles and functions of the psychiatric mental health nurse.^ This dissertation will describe the current nursing shortage; the decline in enrollment to nursing programs; the history of psychiatric nursing as a discipline; the shortage of psychiatric mental health nurses; factors contributing to the psychiatric nursing shortage and a plan for a solution to the nursing shortage in psychiatry.^ The paper focuses on an evaluation conducted on an internship curriculum designed to facilitate effective nursing care in the treatment of clients who exhibit emotional problems. The purpose of this study was to attract and retain nurses to employment opportunities in four Hospital Corporation of America (HCA) facilities, using a six week internship program.^ The study will yield an analysis of the effect of combining psychodynamic principles and knowledge with skills in the clinical area. The demands of educational practice have been merged with the discipline of psychiatric nursing in the development of this curriculum. ^

The body matters: Understanding social differences in mental health

This doctoral dissertation illuminates the salience of body image to sociological investigations of mental health. It is argued that concerns over body-appearance evident in America embody a dimension of distress over the physical self that may be appropriately considered a mental health outcome, called body dysphoria. Using cross-sectional data on 1,183 young adults comprising Hispanic, African American, and non-Hispanic white males and females from varying social classes, a valid and reliable measure of body dysphoria is developed and demonstrated to be a distinct dimension of psychological distress. ^ From the standpoint of the sociology of mental health, the social distribution of body dysphoria makes known individual consequences of the stratified arrangements of society based on gender, race/ethnicity, and social class. Results reveal significant social differences in body dysphoria that are both consistent with and contrary to clinical studies attributing eating disorders to white, upper-class females. Body dysphoria is substantially greater among females supporting that unrealistic cultural ideals and standards of body-appearance remain disproportionately targeted at females in the development and presentation of self. Compared to non-Hispanic whites, Hispanics exhibit higher average levels of body dysphoria while African Americans exhibit lower levels of comparable proportion. The question is addressed whether identification with the dominant (white) culture influences distress over body-appearance among racial/ethnic minorities. A small inverse association is revealed between social class origin and body dysphoria suggesting that individuals from lower social class backgrounds are as greatly affected by body image concerns generally presumed to preoccupy upper social classes. ^ The stress process is a widely used theoretical paradigm for explaining structurally driven social differences in mental health outcomes. New evidence is introduced that the stress process may contribute to understanding body image problems. Regression analyses reveal that stress exposure has a significant positive association with body dysphoria that is mediated by varying psychosocial resources. Overall, the stress process explains the effects of social class origin and African American race/ethnicity on body dysphoria but does not account for the larger effects of being female or Hispanic. ^

A Suite of Prey Traits Determine Predator and Nutrient Enrichment Effects in a Tri-Trophic Food Chain

Predation, predation risk, and resource quality affect suites of prey traits that collectively impact individual fitness, population dynamics, and community structure. However, studies of multi-trophic level effects generally focus on a single prey trait, failing to capture trade-offs among suites of covarying traits that govern population responses and emergent community patterns. We used structural equation models (SEM) to summarize the non-lethal and lethal effects of crayfish, Procambarus fallax, and phosphorus (P) addition, which affected prey food quality (periphyton), on the interactive effects of behavioral, morphological, developmental, and reproductive traits of snails, Planorbella duryi. Univariate and multivariate analyses suggested trade-offs between production (growth, reproduction) and defense (foraging behavior, shell shape) traits of snails in response to non-lethal crayfish and P addition, but few lethal effects. SEM revealed that non-lethal crayfish effects indirectly limited per capita offspring standing stock by increasing refuge use, slowing individual growth, and inducing snails to produce thicker, compressed shells. The negative effects of non-lethal crayfish on snails were strongest with P addition; snails increased allocation to shell defense rather than growth or reproduction. However, compared to ambient conditions, P addition with non-lethal crayfish still yielded greater per capita offspring standing stock by speeding individual snail growth enabling them to produce more offspring that also grew faster. Increased refuge use in response to non-lethal crayfish led to a non-lethal trophic cascade that altered the spatial distribution of periphyton. Independent of crayfish effects, snails stimulated periphyton growth through nutrient regeneration. These findings illustrate the importance of studying suites of traits that reveal costs associated with inducing different traits and how expressing those traits impacts population and community level processes.

Effectiveness of skills- versus metacognitive strategy-based approaches on reading comprehension of college developmental students

This study explored the relative value of behavioral and cognitive psychology as the basis of instruction for underprepared college students enrolled in developmental reading courses. Specifically this study examined the effects of a metacognitive strategy-based instructional approach (MSIA) modeling a metacognitive self-questioning technique (MSQT) versus a traditional skills-based instructional approach (SIA) on the Nelson-Denny reading comprehension scores of college developmental readers and whether there were significant differences in achievement based on instructional method used and on the sex of students. The sample consisted of 100 college developmental reading students who were enrolled in six intact sections of a reading course (REA0002). Participants completed a pretest of the comprehension subtest of the Nelson-Denny Reading Test (Form G). Three of these classes (n = 49) were taught using metacognitive-strategy instruction and three classes (n = 51) were instructed using skills-based instruction. They then received a semester of instruction intended to improve their reading comprehension. At the end of the semester, participants completed a post-test of the Nelson-Denny Reading Comprehension Test (Form H). A two (Between) x one (Within) Repeated Measures Analysis of Variance (ANOVA) was utilized to test each of the hypotheses of this study. Results showed that there were no significant differences in reading comprehension between the groups receiving the different instructional treatments and no differences in reading comprehension between the men and women participants. Based on the findings, implications for research and recommendations for future research were discussed.

Judging psychology experts: Can judges and attorneys distinguish between clinical and experimental psychologists?

A trial judge serves as gatekeeper in the courtroom to ensure that only reliable expert witness testimony is presented to the jury. Nevertheless, research shows that while judges take seriously their gatekeeper status, legal professionals in general are unable to identify well conducted research and are unable to define falsifiability, error rates, peer review status, and scientific validity (Gatkowski et al., 2001; Kovera & McAuliff, 2000). However, the abilities to identify quality scientific research and define scientific concepts are critical to preventing "junk" science from entering courtrooms. Research thus far has neglected to address that before selecting expert witnesses, judges and attorneys must first evaluate experts' CVs rather than their scientific testimony to determine whether legal standards of admissibility have been met. The quality of expert testimony, therefore, largely depends on the ability to evaluate properly experts' credentials. Theoretical models of decision making suggest that ability/knowledge and motivation are required to process information systematically. Legal professionals (judges and attorneys) were expected to process CVs heuristically when rendering expert witness decisions due to a lack of training in areas of psychology expertise.^ Legal professionals' (N = 150) and undergraduate students' (N = 468) expert witness decisions were examined and compared. Participants were presented with one of two versions of a criminal case calling for the testimony of either a clinical psychology expert or an experimental legal psychology expert. Participants then read one of eight curricula vitae that varied area of expertise (clinical vs. legal psychology), previous expert witness experience (previous experience vs. no previous experience), and scholarly publication record (30 publications vs. no publications) before deciding whether the expert was qualified to testify in the case. Follow-up measures assessed participants' decision making processes.^ Legal professionals were not better than college students at rendering quality psychology expert witness admissibility decisions yet they were significantly more confident in their decisions. Legal professionals rated themselves significantly higher than students in ability, knowledge, and motivation to choose an appropriate psychology expert although their expert witness decisions were equally inadequate. Findings suggest that participants relied on heuristics, such as previous expert witness experience, to render decisions.^

The impact of friends on newly immigrant children's emotional and behavioral adjustment

Immigration disrupts an individual's support network; however, the stresses of the immigration process increase the need for social support. The presence of social support becomes essential for immigrant children and adolescents to cope with these important transitional circumstances. Friends are both sources of social support and models for behavior. Furthermore, friendship networks are known to have a significant influence on youths' functioning. Literature suggests that peer relations become more important in adolescence and friend support is related to child and adolescent well-being. Thus, friend relationships may be particularly important for immigrant youths who experience disruption in their friendship networks during the process of migration to another country. In addition to friendship networks and support, friend characteristics also need to be taken into consideration as important factors for immigrant youth adjustment. My study involved analyses of the effects of friend support and friend problem behaviors on emotional and behavioral functioning for elementary, middle, and high school age newly immigrant children and adolescents. ^ Immigrant children and adolescents (N = 503) were interviewed at schools by interviewers fluent in participants' languages. Structural Equation Modeling (SEM) analyses revealed that friend support and friend problem behaviors were related to children's self-esteem and externalizing behaviors. In addition, friend problem behavior alone predicted children's psychological symptoms and depression scores. Furthermore, age/grade was found to be a moderator for the relation between friend problem behavior and immigrant youth behavioral adjustment such that compared to elementary and high school cohorts, middle school youths showed more externalizing behaviors when they had friends performing problem behaviors. ^ Results supported the idea that both friend support and friend behavior are related to newly immigrant youths' emotional and behavioral adjustment. This study informs further research and interventions concerning the development of programs to facilitate immigrant youths' adjustment by revealing friendship factors related to their adaptation.^

Group cognitive -behavioral therapy for heterogeneous anxiety disorders in children and adolescents: A multiple baseline study

This study investigated the efficacy of Group Cognitive-Behavioral Therapy (GCBT) in the treatment of heterogeneous anxiety disorders in children. A partially nonconcurrent multiple baseline across groups design was used to assess the effects of the treatment on 12 clinically referred children and adolescents between 6 and 16 years of age who met DSM-IV criteria for an anxiety disorder. Targeted diagnoses included Obsessive Compulsive Disorder, Simple Phobia, Separation Anxiety Disorder, Social Phobia, and Generalized Anxiety Disorder, with three of the children also presenting with school refusal behavior. Duration of baseline for each of the three groups varied and ran for one, two, or three weeks. Dependent measures included diagnostic status, child and parent-completed reports, and daily child and parent ratings of child anxiety severity. Results indicated that GCBT was efficacious in reducing anxious symptoms in children and adolescents treated in diagnostically heterogeneous groups, and that gains were generally maintained at 6 and 12 month follow-ups. Findings are discussed in terms of their theoretical and practical implications for the efficient treatment of children and adolescents with anxiety disorders. ^

The Impact of Friends on Newly Immigrant Children’s Emotional and Behavioral Adjustment

Immigration disrupts an individual’s support network; however, the stresses of the immigration process increase the need for social support. The presence of social support becomes essential for immigrant children and adolescents to cope with these important transitional circumstances. Friends are both sources of social support and models for behavior. Furthermore, friendship networks are known to have a significant influence on youths’ functioning. Literature suggests that peer relations become more important in adolescence and friend support is related to child and adolescent well-being. Thus, friend relationships may be particularly important for immigrant youths who experience disruption in their friendship networks during the process of migration to another country. In addition to friendship networks and support, friend characteristics also need to be taken into consideration as important factors for immigrant youth adjustment. My study involved analyses of the effects of friend support and friend problem behaviors on emotional and behavioral functioning for elementary, middle, and high school age newly immigrant children and adolescents. Immigrant children and adolescents (N = 503) were interviewed at schools by interviewers fluent in participants’ languages. Structural Equation Modeling (SEM) analyses revealed that friend support and friend problem behaviors were related to children’s self-esteem and externalizing behaviors. In addition, friend problem behavior alone predicted children’s psychological symptoms and depression scores. Furthermore, age/grade was found to be a moderator for the relation between friend problem behavior and immigrant youth behavioral adjustment such that compared to elementary and high school cohorts, middle school youths showed more externalizing behaviors when they had friends performing problem behaviors. Results supported the idea that both friend support and friend behavior are related to newly immigrant youths’ emotional and behavioral adjustment. This study informs further research and interventions concerning the development of programs to facilitate immigrant youths’ adjustment by revealing friendship factors related to their adaptation.

Individual Child Cognitive Behavioral Treatment versus Child-Parent Cognitive Behavioral Treatments for Anxiety Disorders in Children and Adolescents: Comparative Outcomes

Anxiety disorders; such as separation anxiety disorder, generalized anxiety disorder, social phobia and specific phobia, are widespread in children and adolescents. Cognitive behavioral therapy (CBT) has been shown to be effective in reducing excessive fears and anxieties in children and adolescents. Research has produced equivocal findings that involving parents in treatment of child anxiety enhances effects over individual CBT (ICBT). The present dissertation study examined whether parental involvement can enhance individual treatment effect if the parent conditions are streamlined by targeting specific parental variables. The first parent condition, Parent Reinforcement Skills Training (RFST), involved increasing mothers’ use of positive reinforcement and decreasing use of negative reinforcement. The second parent condition, Parent Relationship Skill Training (RLST), involved increasing maternal child acceptance and decreasing maternal control (or increasing autonomy granting). Results of the present dissertation findings support the use of all three treatment conditions (ICBT, RLST, RFST) for child anxiety; that is, significant reductions in anxiety were found in each of the three treatment conditions. No significant differences were found between treatment conditions with respect to diagnostic recovery rate, clinician rating, and parent rating of child anxiety. Significant differences between conditions were found on child self rating of anxiety, with some evidence to support the superiority of RLST and RFST to ICBT. These findings support the efficacy of individual, as well as parent involved CBT, and provide mixed evidence with respect to the superiority of parent involved CBT over ICBT. The conceptual, empirical, and clinical implications of the findings are discussed.