Effect of psychological interventions on depressive symptoms in long-term rehabilitation after an acquired brain injury: a systematic review and meta-analysis

OBJECTIVE To summarize empirical studies on the effectiveness of psychological interventions in long-term rehabilitation after an acquired brain injury (ABI) in reducing depressive symptoms. DATA SOURCES A systematic literature search was conducted on MEDLINE, PsycINFO, Embase, and CINAHL to identify articles published between January 1990 and October 2011. Search terms included the 3 concepts (1) "brain injur*" or "stroke," (2) "psychotherap*" or "therapy" or "intervention" or "rehabilitation," and (3) "depress*." STUDY SELECTION Studies evaluating psychological interventions in patients after ABI were included. Time since injury was on average more than 1 year. Trials reported data on validated depression questionnaires before and after the psychological intervention. DATA EXTRACTION Two independent reviewers extracted information from the sample, the intervention, and the outcome of the included studies and calculated effect sizes (ESs) from depression questionnaires. Thirteen studies were included in a pre-post analysis. Seven studies were eligible for a meta-analysis of ESs in active interventions and control conditions. DATA SYNTHESIS Pre-post ESs were significant in 4 of 13 studies. The overall ES of .69 (95% confidence interval [CI], .29-1.09) suggests a medium effectiveness of psychological interventions on depressive symptoms compared with control conditions. Moderator analysis of the number of sessions and adequate randomization procedure did not show significant ES differences between strata. Studies with adequate randomization did not, however, suggest the effectiveness of psychological interventions on depressive symptoms after ABI. CONCLUSIONS Psychological interventions are a promising treatment option for depressive symptoms in long-term rehabilitation after ABI. Since only a few adequately randomized controlled trials (RCTs) exist, more RCTs are required to confirm this initial finding.

Information Integration Theory and the Construction of Individually Perceived Group Efficacy

According to Bandura (1997) efficacy beliefs are a primary determinant of motivation. Still, very little is known about the processes through which people integrate situational factors to form efficacy beliefs (Myers & Feltz, 2007). The aim of this study was to gain insight into the cognitive construction of subjective group-efficacy beliefs. Only with a sound understanding of those processes is there a sufficient base to derive psychological interventions aimed at group-efficacy beliefs. According to cognitive theories (e.g., Miller, Galanter, & Pribram, 1973) individual group-efficacy beliefs can be seen as the result of a comparison between the demands of a group task and the resources of the performing group. At the center of this comparison are internally represented structures of the group task and plans to perform it. The empirical plausibility of this notion was tested using functional measurement theory (Anderson, 1981). Twenty-three students (M = 23.30 years; SD = 3.39; 35 % females) of the University of Bern repeatedly judged the efficacy of groups in different group tasks. The groups consisted of the subjects and another one to two fictive group members. The latter were manipulated by their value (low, medium, high) in task-relevant abilities. Data obtained from multiple full factorial designs were structured with individuals as second level units and analyzed using mixed linear models. The task-relevant abilities of group members, specified as fixed factors, all had highly significant effects on subjects’ group-efficacy judgments. The effect sizes of the ability factors showed to be dependent on the respective abilities’ importance in a given task. In additive tasks (Steiner, 1972) group resources were integrated in a linear fashion whereas significant interaction between factors was obtained in interdependent tasks. The results also showed that people take into account other group members’ efficacy beliefs when forming their own group-efficacy beliefs. The results support the notion that personal group-efficacy beliefs are obtained by comparing the demands of a task with the performing groups’ resources. Psychological factors such as other team members’ efficacy beliefs are thereby being considered task relevant resources and affect subjective group-efficacy beliefs. This latter finding underlines the adequacy of multidimensional measures. While the validity of collective efficacy measures is usually estimated by how well they predict performances, the results of this study allow for a somewhat internal validity criterion. It is concluded that Information Integration Theory holds potential to further help understand people’s cognitive functioning in sport relevant situations.

Factors influencing the quality of the consultation process

Sport psychology services have become to be an important brick stone when building athletic success. The strive for better performance is not only a characteristic of athletes, but of the whole support system in top level sport including sport psychology. Sport psychology consultants are permanently challenged to deliver highest quality services to their clients if they do not want to lose their contracts. Sport psychologists are continuously improving their consulting skills, learn new intervention techniques, read scientific papers and, last but not least, gain experience by accumulating hours of deliberate practice (Ericsson) in sport psychology. Even with increasing experience, the consultant has a certain number of degrees of freedom and has to make a series of decisions about how he or she wants to work. Quality, however, depends on a number of issues, and not all of them are under direct control of the consultant. It is argued that, in order for these choices being good, the following factors - among others - must be considered: Who is seeking assistance? What are the "issues and problems" (Gardner & Moore, 2006) the athlete is confronted with? What kind of approaches do fit with the client's need? Who is the 'client' the sport psychologist is supposed to work with? If it is a team, is the sport psychologist supposed to work with a number of individuals, with the coach, or with the whole system? Where are the boundaries of the system? What is the role of the sport psychologist in the sport system? All these issues directly affect the process and outcome quality of the sport psychology consultant. A sound theoretical basis, in connection with a distinct philosophy of the intervention, is an important cornerstone for the quality of sport psychology consultation.

Efficient team actions: Outline of a theory of teams in sport

So far, social psychology in sport has preliminary focused on team cohesion, and many studies and meta analyses tried to demonstrate a relation between cohesiveness of a team and it's performance. How a team really co-operates and how the individual actions are integrated towards a team action is a question that has received relatively little attention in research. This may, at least in part, be due to a lack of a theoretical framework for collective actions, a dearth that has only recently begun to challenge sport psychologists. In this presentation a framework for a comprehensive theory of teams in sport is outlined and its potential to integrate the following presentations is put up for discussion. Based on a model developed by von Cranach, Ochsenbein and Valach (1986), teams are information processing organisms, and team actions need to be investigated on two levels: the individual team member and the group as an entity. Elements to be considered are the task, the social structure, the information processing structure and the execution structure. Obviously, different task require different social structures, communication and co-ordination. From a cognitivist point of view, internal representations (or mental models) guide the behaviour mainly in situations requiring quick reactions and adaptations, were deliberate or contingency planning are difficult. In sport teams, the collective representation contains the elements of the team situation, that is team task and team members, and of the team processes, that is communication and co-operation. Different meta-perspectives may be distinguished and bear a potential to explain the actions of efficient teams. Cranach, M. von, Ochsenbein, G., & Valach, L. (1986).The group as a self-active system: Outline of a theory of group action. European Journal of Social Psychology, 16, 193-229.

Ultrasound of the axillary arch muscle in children

Purpose: Unilateral or bilateral axillary masses in children are often of clinical concern for malignancies. Our review illustrates a normal variant of the axilla mimicking clinically an axillary mass. Methods and Materials: Systematic review of our PACS and RIS with the keyword “axilla” and the modality “ultrasound” in children under 16 years of age from 1.12.2009 until 30.11.2012. 19 axillary ultrasound examinations in 16 patients (7m/9f, age 3 months to 15 years) were included. One patient was examined 2 and one patient 3 times. In 6 patients a prominent muscle was noted overlying the humeral head in an abducted position. The muscle diameter was measured in cm and compared with the contralateral side. In one patient photographs of the axilla were available. Results: In 16 examinations a lymphadenopathy (n=5), abscess formation (n=5), seroma or hematoma (n=1) or lymphangioma (n=1) and no diagnosis (n=1) was found. In 4 patients (25%) a unilateral muscle variant and in 2 patients a bilateral muscle variant (axillary arch muscle) was noted. In one patient a duplication of the muscle was found. In 4 patients the muscle was larger than the contralateral side. Conclusion: An axillary mass in children without other clinical complaints may be related to a normal variant, the axillary arch muscle. Ultrasound is the first modality of choice if imaging is required. Radiologists should be aware of this normal variant since no other workup is necessary in asymptomatic children.

Validation of a paradigm to measure instrumental aggression (iap) on a sample of male adolescents with adjustment problems

Aggressive behavior can be classified in hostile and instrumental aggressions (anderson & bushman, 2002). this classification is mostly synonymously used with reactive and proactive aggression, whereas the differences between hostile and instrumental aggression lie on three dimensions, the primary goal, amount of anger and planning and calculation(bushman & anderson, 2001). although there are rating instruments and experimental paradigms to measure hostile aggression, there is no instrument to measure instrumental aggression. the following study will present an account to measure instrumental aggression with an experimental laboratory paradigm. the instrument was firstly tested on two samples of normal young adolescents (n1 = 100; amage. = 19.14; n2 = 60; amage. = 21.46). the first study revealed a strong correlation with a laboratory aggression paradigm measuring hostile aggression, but no correlations with self-reported aggression in the buss and perry questionnaire. these results were replicated in a second study, revealing an additional correlation with aggressive but not adaptive assertiveness. secondly the instrument was part of the evaluation of the reasoning and rehabilitation program r&r2 (ross, hilborn & lidell, 1984) in an institution for male adolescents with adjustment problems in switzerland. the r&r2 is a cognitive behavioral group therapy to reduce antisocial and promote prosocial cognitions and behavior. the treatment group (n= 16; rangeage = 15-17) is compared to a no treatment control group (n=24; rangeage = 17-19) preand post- treatment. further aggressive behavior was surveyed and experimentally measured. hostile rumination, aggressive and adaptive assertiveness, emotional and social competence were included in the measurement to estimate construct validity.

Interferon-α antagonizes IL-3-mediated immunoregulatory functions of human basophils

Human basophils are major inflammatory cells in maintaining chronic allergic asthma. It has been published that interferon-α (IFN-α) improves clinical symptoms of asthma patients. In contrast, IL-3 exacerbates airway inflammation by inducing IL-4, IL-8 and IL-13 secretion from human basophils thus regulating their immunoregulatory functions. Furthermore, IL-3 exceptionally promotes survival of basophils. Here, we assessed cellular response of human basophils treated with IFN-α alone or in combination with IL-3. Our data show that IFN-α enhances apoptosis in purified human blood basophils compared to spontaneous apoptosis of controls or IFN-γ treated cells. Furthermore, we demonstrate that both IFN-α and FasL enhance apoptosis in human basophils with similar efficiency in a rather additive than synergistic way. IFN-α inhibits IL-3-induced survival to a minor degree. Particularly however, it suppresses IL-3-induced de-novo production of IL-8 and IL-13 up to 80%. In contrast, the production of IL-4 is not affected. Analyses of signaling pathways reveal that IFN-α promotes prolonged phosphorylation of STAT1/STAT2. By using a pan-JAK inhibitor the phosphorylation of STAT1/STAT2 is inhibited and most importantly the pro-apoptotic effect of IFN-α is abolished. Although the phosphorylation of p38-MAPK in IFN-α-treated cells is comparable to non-treated cells, inhibition of p-p38 activity abrogates IFN-α-enhanced apoptosis as well. We conclude that IFN-α-enhanced apoptosis is tightly regulated by the cooperation of JAK/STAT and p38-MAPK pathways. Our study identifies IFN-α as a novel inhibitor of IL-3-induced IL-8 and IL-13 production of human basophils. Taken together our study may explain the improved clinical symptoms of asthma patients treated with IFN-α.

Who’s to blame? How narcissists and ex-partners of narcissists make sense of romantic breakup

Objective: past research has shown relationship problems associated with narcissists’ excessive self-centeredness and lacking concern for others. Using romantic relationships as opportunities to self-enhance rather than caring about intimacy, narcissists are sensitive to shortcomings in their partners and quick to withdraw investment once relationships turn out to be less than perfect. Our research aimed to reveal whether narcissists are aware of their destructive relationship behavior or tend to put the blame for a failed relationship on their ex-partners. Conversely, do ex-partners of narcissists take the blame and feel responsible for the breakup or walk away convinced their narcissistic ex-partners’ behavior was just too unbearable? Method: 120 participants (19-59 yrs) who reported a recent romantic breakup completed a battery of questionnaires online, including measures of narcissism and self-esteem, as well as newly created scales assessing attributions for breakup. In addition to self-reports, participants retrospectively rated their ex-partners on adapted versions of the same measures. Results: narcissists made attributions to lacking relationship investment mostly in themselves and to a lesser extent in their partners. However, this pattern was reversed when self-esteem was controlled, with attributions to partner shortcomings outnumbering aspects of own destructive behavior. Narcissism perceived in the ex-partner was related to reports of lacking investment in oneself as well as the ex-partner, but controlling for self-esteem reduced the number of attributions to own shortcomings. Conclusion: our analyses revealed that narcissists do show some awareness of their contribution to a failed relationship, although controlling for self-esteem increased their blame of the ex-partner. In contrast, associations between perceived partner-narcissism and aspects of own lacking relationship investment became fewer when self-esteem was controlled for.

A view through gloomy glasses: accuracy and bias in relationships of narcissists

Narcissists’ perception of others is marked by a negative bias in the service of their own self-enhancement. The aim of this study was to determine whether narcissists’ negative bias extends to the perception of romantic partners too. In addition, we explored whether partners of narcissists succumb to specific perception biases as well. During 14 days, 86 couples completed measures of support given to and received from their partners. The results indicated that both male and female narcissists were more accurate in detecting negative support (e.g., blaming the partner for his or her problems) received from their partners, while female narcissists only were less accurate in perceiving altruistic support motives (e.g., truly enjoying to help the partner) of their male partner. Moreover, narcissists as well as their partners displayed a negative bias by underestimating the amount of altruistic support motives reported by each of them. On the other hand, partners of narcissists were positively biased as well and underestimated the negative support given by the narcissists. Results are discussed in relation to the self-regulatory goals of narcissists and of their partners and with respect to the possible impact of their accuracy and biases on the couple wellbeing.