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Biomedical subjects

Howard Tennen

Publications and source records attributed to Howard Tennen.

At least 19 recordsLinked to original sources
PubMed2007

Health psychology: psychological adjustment to chronic disease.

Chronic diseases carry important psychological and social consequences that demand significant psychological adjustment. The literature is providing increasingly nuanced conceptualizations of adjustment, demonstrating that the experience of chronic disease necessitates adaptation in multiple life domains. Heterogeneity in adjustment is apparent between individuals and across the course of the disease trajectory. Focusing on cancer, cardiovascular disease, and rheumatic diseases, we review longitudinal investigations of distal (socioeconomic variables, culture/ethnicity, and gender-related processes) and proximal (interpersonal relationships, personality attributes, cognitive appraisals, and coping processes) risk and protective factors for adjustment across time. We observe that the past decade has seen a surge in research that is longitudinal in design, involves adequately characterized samples of sufficient size, and includes statistical control for initial values on dependent variables. A progressively convincing characterization of risk and protective factors for favorable adjustment to chronic illness has emerged. We identify critical issues for future research.

Adaptation, Psychological↗
PubMed2006

Brief motivational enhancement and coping skills interventions for heavy drinking.

Two brief (3-session) interventions were evaluated in a community sample of 98 non-dependent heavy drinking adults. Three weeks of intensive daily monitoring of drinking using a hand-held computer were completed before and after a 3-week intervention phase in which participants were randomly assigned to a brief coping skills, brief motivational enhancement, or waiting list condition. Waiting list participants drank more before, during, and after the brief intervention than brief intervention subjects, but all participants demonstrated reductions in drinking amount and frequency. No differences in drinking were found between the two brief interventions. The potential value of intensive daily monitoring as a tool for non-alcohol dependent individuals interested in reducing their drinking was considered.

Adaptation, Psychological↗
PubMed2006

Interactive effects of the serotonin transporter 5-HTTLPR polymorphism and stressful life events on college student drinking and drug use.

BACKGROUND: A common functional polymorphism, 5-HTTLPR, in the serotonin transporter gene has been associated with heavy drinking in college students. We examined this polymorphism as it interacted with negative life events to predict drinking and drug use in college students. METHODS: Daily reports of drinking and drug use obtained using a daily web-based survey were combined with self-reports of past-year negative life events and 5-HTTLPR genotypes in a regression analysis of alcohol and nonprescribed drug use in a sample of 295 college students. RESULTS: Genotype and negative life events significantly interacted in relation to drinking and drug use outcomes. Individuals homozygous for the short (s) allele who experienced multiple negative life events in the prior year reported more frequent drinking and heavy drinking, stronger intentions to drink, and greater nonprescribed drug use. In individuals homozygous for the long (l) allele, drinking and drug use were unaffected by past-year negative life events. Heterozygous subjects showed drinking outcomes that were intermediate to the two homozygous groups. CONCLUSIONS: The 5-HTTLPR s-allele is associated with increased drinking and drug use among college students who have experienced multiple negative life events. The s-allele carriers may be at risk for a variety of adverse behavioral outcomes in response to stress.

Adolescent↗
PubMed2006

Coping with rheumatoid arthritis pain in daily life: within-person analyses reveal hidden vulnerability for the formerly depressed.

This study examined the association between history of depression and day-to-day coping with rheumatoid arthritis (RA) pain. The sample was 188 RA-diagnosed participants, 73 of whom were identified by a structured clinical interview as having a history of major depression. None had current major depression. All participated in a 30-day prospective study in which they made end-of-day ratings of their arthritis pain, the strategies for how they coped with their pain, their appraisals of daily pain, and daily mood. Hierarchical linear models evaluated whether individuals with and without depression history differed in their average pain and the other daily measures; and separately, whether they differed in their within-person associations between pain and the daily measures (e.g., the day-to-day contingency between pain and mood). All analyses controlled for current mild depressive symptoms, neuroticism, and age. Previously depressed individuals were indistinguishable from their never depressed peers in their average pain and the other daily measures; however, the previously depressed exhibited significantly stronger associations between pain and several aspects of their daily emotional experience, suggesting more pain-contingent well-being. For individuals with a history of depression, increases in daily pain corresponded with more frequent efforts to cope with their pain by venting their emotions, significantly stronger impairments in mood, and, if they were also presently distressed, reduced perceptions of control over their pain, compared to the never depressed. Patterns suggest that formerly depressed individuals exhibit a hidden vulnerability in how they manage chronic pain. This vulnerability is best revealed by a daily process approach.

Adaptation, Psychological↗
PubMed2006

Daily interpersonal events in pain patients: applying action theory to chronic illness.

Action theory proposes that individuals actively shape and then respond to their environments, highlighting the role of stable person characteristics in the development and maintenance of life's interpersonal difficulties. In this study, the authors adopt the action perspective in their examination of predictors of daily interpersonal events among chronic pain patients with rheumatoid arthritis. They probe the extent to which stable symptoms of illness explained between-person variation, and fluctuating symptoms explain day-to-day variation in both positive and negative events. Their evaluation of patients' daily diary reports indicate that between-person differences accounted for more variance in the occurrence of positive events relative to negative events (48% vs. 31%, respectively). Likewise, between-person factors accounted for more variance in appraisals of positive compared to negative events across relationship domains. Both intractable illness symptoms and disability, and daily fluctuations in pain and fatigue, were only weakly related to patients' reports of their interpersonal experiences. Consistent with action theory, these results suggest that stable person characteristics are strongly related to daily stressors and particularly daily positive events in pain patients, but still account for less than 50% of the variance in events and their appraisals. In contrast, elevations in illness-related features, both between individuals and within individuals from day-to-day, are not robust predictors of positive or negative social exchanges. These findings point to the value of capturing the experiences of individuals intensively over time, an approach that can help to elaborate the contributions of both stable factors and circumstance in shaping social contexts in chronic illness.

Activities of Daily Living↗
PubMed2006

Depression history and coping with chronic pain: a daily process analysis.

This study examined how a previous episode of depression is related to daily pain and reactions to pain among individuals with fibromyalgia, a chronic pain syndrome. Seventy-one women with fibromyalgia (including 30 who were previously depressed) rated their pain and mood 3 times daily for 30 days. Each night, participants rated the extent to which they responded to pain by catastrophizing, how much control they had over that day's pain, their ways of coping with pain that day, and the effectiveness of their coping efforts. Multivariate multilevel regression models revealed that after controlling for neuroticism and current depressive symptoms, formerly depressed and never-depressed individuals differed in how they coped with increased pain and in how they appraised the efficacy of their coping efforts. Formerly depressed participants who also reported more current depressive symptoms showed a greater decline in pleasant mood on more painful days than did formerly depressed participants who were experiencing fewer current depressive symptoms. These findings illustrate how a history of depression can be captured in the dynamics of daily life.

Adaptation, Psychological↗
PubMed2006

The effects of naltrexone on alcohol consumption and affect reactivity to daily interpersonal events among heavy drinkers.

The authors examined whether the associations among daily positive and negative interpersonal events, alcohol consumption, and affect varied as a function of naltrexone or placebo administered in a targeted (in anticipation of or in response to high-risk drinking situations) or daily fashion. Heavy drinkers (N = 149) received 4 sessions of brief coping skills counseling in addition to 8 weeks of naltrexone treatment. They recorded for 8 weeks in structured nightly diaries their interpersonal interactions, affect, and alcohol consumption. The authors predicted that participants receiving naltrexone, compared with those taking placebo, would drink less in response to interpersonal encounters and that naltrexone administration would attenuate the link between positive interpersonal events and positive affective states. Results indicated that both positive and negative interpersonal interactions were associated with an increased probability of engaging in any drinking and that positive daily social celebratory events were associated with an increased probability of engaging in heavy drinking. Participants taking naltrexone in a targeted fashion showed the strongest positive association between the number of positive social celebratory events and drinking. Although this finding was inconsistent with the overall reduction in drinking that has been generally reported for those treated with naltrexone, positive social celebratory events occurred on only a minority of days. Participants taking naltrexone, compared with those taking placebo, showed weaker associations between positive social celebratory events and positive and negative affective states. Findings are discussed in terms of naltrexone's dampening effects on the rewarding properties of alcohol use and certain positively valenced stimuli.

Adolescent↗
PubMed2006

Paper and plastic in daily diary research: Comment on Green, Rafaeli, Bolger, Shrout, and Reis (2006).

The authors applaud A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) response to one-sided comparisons of paper versus electronic (plastic) diary methods and hope that it will stimulate more balanced considerations of the issues involved. The authors begin by highlighting areas of agreement and disagreement with Green et al. The authors review briefly the broader literature that has compared paper and plastic diaries, noting how recent comparisons have relied on study designs and methods that favor investigators' allegiances. The authors note some sorely needed data for the evaluation of the implications of paper versus plastic for the internal and external validity of research. To facilitate evaluation of the existing literature and assist in the design of future studies, the authors offer a balanced comparison of paper and electronic diary methods across a range of applications. Finally, the authors propose 2 study designs that offer fair comparisons of paper and plastic diary methods.

Adolescent↗
PubMed2006

Targeted versus daily naltrexone: secondary analysis of effects on average daily drinking.

BACKGROUND: To extend our previous findings that naltrexone reduced the likelihood of heavy drinking on a given day among problem drinkers, while targeted administration reduced the likelihood of any drinking, we examined the effects of naltrexone and targeted administration on the continuous outcome of drinks/day. Because treatment response may differ by gender, we also compared the effects on this factor. METHODS: In a double-blind, placebo-controlled study, problem drinkers (n=150, 58% men) were randomly assigned to 8 weeks of treatment with naltrexone (50 mg/day) or placebo, either daily or on a targeted schedule. All subjects also received brief coping skills therapy. To complement the traditional regression analysis conducted previously, a zero-inflated Poisson regression model was used to examine the effects of medication, schedule of administration, and gender on the number of standard drinks consumed daily. RESULTS: Targeted naltrexone, and to a lesser extent targeted placebo, yielded a greater reduction in daily drinking than did daily placebo, an effect that did not differ by gender and that was greater than that seen for daily naltrexone treatment. Relative to daily placebo, daily naltrexone reduced the number of drinks/day only among men, at the level of a nonsignificant trend. CONCLUSIONS: Although in both genders, targeted treatments appeared to reduce the volume of drinking, treatment with targeted naltrexone was somewhat better. In contrast, heavy drinking women showed no benefit from daily naltrexone treatment. Further evaluation of the efficacy of targeted treatments and of daily naltrexone and the relationship of these treatments with gender is warranted.

Adolescent↗
PubMed2006

Organizational assessment in paediatric primary care: development and initial validation of the primary care organizational questionnaire.

Primary care in the United States is undergoing many changes. Reliable and valid instruments are needed to assess the effects of these changes. The Primary Care Organizational Questionnaire (PCOQ), a 56-item 5-point Likert scale survey that evaluates interactions among members of the clinic/practice and job-related attributes, was administered to clinicians and staff in 36 primary care practices serving paediatric populations in Connecticut. A priori scales were reliable (Cronbach alpha > or = 0.7). Analysis of variance (ANOVA) showed greater heterogeneity across clinics than within clinics for 13 of 15 a priori scales, which were then included in a principal component factor analysis with varimax rotation. Eigenvalue analysis showed nine significant factors, largely similar to the a priori scales, indicating concurrent construct validity. Further research will ascertain the utility of the PCOQ in predicting the effectiveness of primary care practices in implementing disease management programmes.

Adult↗
PubMed2005

Relationship of anxiety, depression and alcohol use disorders to persistent high utilization and potentially problematic under-utilization of primary medical care.

Psychiatric disorders in primary medical care are prevalent, frequently undetected, under-treated, and costly. Studies report that psychiatric disorders are associated with high utilization of healthcare, but the stability of high utilization has not been systematically examined. Medical records data for 500 primary care patients in Connecticut, USA, representing high and modal utilization levels were examined over a 2-year period. In multi-variate analyses, only anxiety disorders were associated with persistent high utilization of primary care, as well as with inconsistent attendance. Alcohol use disorders were inversely associated with persistent high utilization, and positively related to inconsistent attendance and low complexity services (determined by evaluation and management coding). Depression was associated with low complexity primary care services and inconsistent attendance. Anxiety disorders and mixed anxiety-depression disorders warrant attention as potential contributors to persistent high or inconsistent utilization of primary healthcare. Alcohol use disorders may be under-treated in primary care due to inconsistent attendance, few visits, and low complexity services.

Adolescent↗
PubMed2005

Teach our students well: a call for training models that embrace the wisdom of the past.

C.R. Snyder and T.R. Elliott's forward-looking clinical training model (this issue, pp. 1033-1054) assumes that traditional clinical theories, particularly psychoanalytic theories, have little to offer the study of human strengths. Yet the psychoanalytic literature reveals many insights into the nature of strengths and weaknesses. This essay describes a three-pronged habit of thinking that has led positive psychology advocates, including Snyder and Elliott, to underestimate the potential contribution of psychoanalytic models to our understanding of human strengths and to training models that stress their importance.

Achievement↗
PubMed2005

Unilateral spatial neglect: relation to rehabilitation outcomes in patients with right hemisphere stroke.

OBJECTIVE: To examine the relation between left unilateral spatial neglect (USN) and rehabilitation outcomes in patients with right hemisphere stroke. DESIGN: A retrospective analysis of a database of right hemisphere stroke patients. SETTING: Acute inpatient rehabilitation hospital. PARTICIPANTS: Patients (N=175) with a diagnosis of right hemisphere stroke who had undergone a neuropsychologic screening including assessment of USN and depressive symptoms at time of admission to an inpatient rehabilitation program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional status was evaluated with the FIM instrument at admission and discharge. The relationship between USN, depressive symptoms, cognitive functioning, length of stay (LOS), and rate of progress in rehabilitation was examined via univariate (correlational) and multivariate (Cox regression) analyses. RESULTS: Patients with USN had longer LOS and progressed more slowly compared with those without USN. When matched against patients with equally poor functional status at admission, USN patients still had longer admissions and progressed more slowly. CONCLUSIONS: USN is a unique predictor of rehabilitation outcomes in patients with right hemisphere stroke. Identification of those specific functional skill areas most affected by USN may make possible the development of targeted interventions aimed at these key areas.

Aged↗
PubMed2005

Moving beyond the keg party: a daily process study of college student drinking motivations.

Theoretical models of alcohol consumption assert that young adults endorse multiple drinking motives, including drinking to cope with negative experiences and to enhance positive experiences. Social contacts may be important to both pathways. This study applied daily process methodology to determine the relationship between college student drinking in different contexts and daily social contacts and moods. Each afternoon for 3 weeks, 122 undergraduates (43% men, 57% women) logged onto a secure Web site during specified hours to report daily activities, moods, and contacts. Hierarchical linear modeling analyses provided support for motivational models and the context-specific nature of motivated drinking. Individual differences were revealed for each motivation. These findings highlight the importance of studying within-person processes using daily process designs.

Adult↗
PubMed2005

Dynamic approaches to emotions and stress in everyday life: Bolger and Zuckerman reloaded with positive as well as negative affects.

A decade ago, Bolger and Zuckerman (1995) incorporated personality into the study of daily life events and psychological distress. Their approach put an entirely new cast on research and theorizing in this area. In their work, they focused on the predominantly negative personality trait of Neuroticism. In this article we extend their work to include theory and measurement of positive events and indicators of well-being. Integrating these research strands offers the possibility of a comprehensive yet highly sensitive and dynamic approach to the study of emotions, stress, and health in everyday life.

Adaptation, Psychological↗
PubMed2005

Personality and daily experience revisited.

In this introduction to the Journal of Personality special issue devoted to "Advances in Personality and Daily Experience" we attempt to trace recent progress in the study of personality and daily life. We begin by comparing and contrasting the methods of daily experience research adopted by investigators who authored empirical articles in the 1991 and current special issues according to the mode, schedule, and sampling frame for data collection. We then compare data analytic strategies across the 14 years between the two special issues and conclude that although the nature of the questions addressed has not changed dramatically, newer analytic methods and associated software have enhanced our ability to answer these questions more precisely. Finally, we provide an overview of the special issue contributions organized around three broad themes: personal vulnerabilities and resources that predict reactions to everyday events, interpersonal manifestations of personality in daily experience, and how personality in daily life affects physical and mental health and relates to disease risk.

Adaptation, Psychological↗
PubMed2005

Drinking to cope: a comparison of questionnaire and electronic diary reports.

OBJECTIVE: The purpose of this article is to assess the correspondence between questionnaire reports of dispositional drinking to cope (DTC) and different indices of daily DTC in a sample of nondependent heavy drinkers. METHOD: Data from electronic diary (ED) records of interpersonal problems, negative affect, coping and drinking were used to examine how questionnaire reports of dispositional DTC corresponded to ED reports of daily DTC and to within-person associations among ED reports of negative affect, interpersonal problems and drinking. In the current study, 98 community-residing heavy drinkers using EDs recorded moods, interpersonal problems, coping attempts, desire to drink and drinking for 21 consecutive days. RESULTS: The findings demonstrate correspondence between questionnaire reports of dispositional DTC and (1) ED reports of daily DTC, (2) intensity of negative mood associated with daily drinking initiation and (3) some between-person differences in within-day prediction of drinking and desire to drink from mood and interpersonal problem ratings. Those reporting higher dispositional DTC were somewhat more likely to drink in response to some negative moods and less likely to drink in response to some positive moods than those reporting relatively lower dispositional DTC, but these findings were mixed. CONCLUSIONS: Questionnaire reports of dispositional DTC are at best inconsistently linked to observed within-person associations among daily moods, interpersonal problems and drinking even among heavy drinkers.

Adaptation, Psychological↗