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Biomedical subjects

S M Kopta

Publications and source records attributed to S M Kopta.

14 recordsLinked to original sources
PubMed2001

Prediction of dose-response relations based on patient characteristics.

The recent discussion of evidence-based, adaptive treatment planning highlights the need for models for the prediction of courses of treatment response. We combine a dose-response model with growth curve modeling to determine dose-response relations for well-being, symptoms, and functioning. Hierarchical linear modeling was used to model each patient's expected course of improvement. The resulting predictions were cross-validated on two samples of psychotherapy outpatients. The results give further empirical support for the dose-response model and the phase model of psychotherapy as well as for the usefulness of patient treatment response profiling for individual treatment management.

Adult↗
PubMed1999

Predicting patients' responses to psychotherapy: are some more predictable than others?

Patient profiling predicts improvement across psychotherapy sessions on the basis of intake clinical characteristics. Patients completed questionnaires before their 1st session and at other points during treatment. After using hierarchical linear modeling to calculate expected courses of improvement, 1/2 of the sample was divided into 1 of 2 groups: those whose treatment responses across sessions matched or exceeded their expected courses (75% of the sample) and those whose responses failed to match expectations. A discriminant function analysis indicated that the groups could be differentiated on the basis of intake characteristics; that is, patients with higher discriminant scores were more likely than those with low discriminant scores to have responded to psychotherapy as predicted. Successful cross-validation of the predictor weights was performed with the other 1/2 of the sample.

Adult↗
PubMed1999

Individual psychotherapy outcome and process research: challenges leading to greater turmoil or a positive transition?

Psychotherapy is facing challenges that relate to the emergence of managed health care, the possibility of a national health care system, and advances in biological psychiatry. These situations have created pressure to achieve a more accurate assessment of psychotherapeutic effectiveness. Psychotherapy has been proven to be generally effective; however, there is uncertainty as to why. The field is currently experiencing apparent turmoil in three areas: (a) theory development for psychotherapeutic effectiveness, (b) research design, and (c) treatment technique. This chapter reviews the dynamics within each of the areas and highlights the progress made in treating mental disorders. We conclude that recent advances in research design may provide a transition that will bring psychotherapy closer to becoming a unified paradigm with an acceptable theory of effectiveness.

Female↗
PubMed1998

Moral volition: the fifth and final domain leading to an integrated theory of conscience understanding.

OBJECTIVES: To define discrete developmental levels of understanding of the ways in which normal children and adolescents link autonomy and will to moral obligation and to study the correlation between this progression and previously identified stages of conscience conceptualization. METHOD: One hundred thirty-two normal volunteers between the ages of 5 and 17 years were individually interviewed using the moral volition section of the semistructured Stilwell Conscience Interview. Analysis of the interviews resulted in five levels of understanding of moral self-evaluation and volitionally chosen behavior. RESULTS: Analyses of variance and covariance showed that the five levels of moral volition had significant correlation with five conceptualization stages, with stage criteria showing a stronger correlation than age. Self-identified tasks of oughtness were hierarchically defined beginning with those defining a morality of restraint followed by moralities of mastery/sufficiency, virtuous striving, idealization, and individual responsibility. Perception of increased independence of self in interaction with conscience was noteworthy at stages 4 and 5. CONCLUSIONS: Moral volition is the domain of conscience functioning that defines understanding of moral self-evaluation and volitionally chosen actions; five levels of understanding can be demonstrated in normal children between the ages of 5 and 17 years.

Adolescent↗
PubMed1997

Maltreatment, conscience functioning and dopamine beta hydroxylase in emotionally disturbed boys.

OBJECTIVE: Identify associations among early maltreatment, sufficiencies, and psychopathological interferences in the domains of conscience functioning and low serum dopamine beta hydroxylase activity. METHOD: Nineteen emotionally disturbed boys screened for maltreatment experiences were compared according to age at onset of maltreatment, enzyme activity, and their conscience functioning in the domain of moral valuation. They were also compared in conscience functions to 19 age and sex matched normal counterparts. RESULTS: Subjects who endured maltreatment prior to 36 months had developmental delays and interferences with functioning in more conscience domains than those who were either spared such experiences or who endured maltreatment later in life. Subjects with low enzyme activity had significantly more interference with authority and peer valuation than subjects with high enzyme activity. Greater interference with valuation was associated with lower enzyme activity and more frequent abuse prior to 36 months. CONCLUSIONS: Psychosocial sequelae of early maltreatment have been identified in the domains of conscience. An association has been established between pathological interference in the domain of moral valuation and a putative neurobiologic sequelae of early maltreatment. Implications for future research in the psychobiology of maltreatment are discussed.

Adolescent↗
PubMed1997

Moralization of attachment: a fourth domain of conscience functioning.

OBJECTIVES: To define discrete developmental levels of understanding regarding the ways in which normal children and adolescents link remembered and current attachment experiences to their moral belief system and to study the correlation between this progression and previously identified stages of conscience conceptualization. METHOD: Using the moralization of attachment section from the semistructured Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were individually interviewed. Analysis of the interviews resulted in five levels of understanding. RESULTS: By analyses of variance and covariance, the five attachment levels showed significant correlation with the five conceptualization stages. Conceptualization stage showed a stronger correlation than age. CONCLUSIONS: In normal development, moralization of attachment is a domain of conscience functioning which follows a five-level hierarchical developmental progression; first, the child's sense of security and empathic responsiveness become paired with a sense of moral obligation; caretaker rules are then incorporated; an understanding of how empathy modifies strict rule-following develops; idols and ideals are chosen that reflect earlier learning in attachment relationships; finally, a visualization of the self as moral standard-bearer or teacher unfolds.

Adolescent↗
PubMed1996

Moral valuation: a third domain of conscience functioning.

OBJECTIVE: To assess development of moral valuation in normal children and adolescents, that is, how moral rules for living are derived and justified, and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. METHOD: Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed. All moral valuation responses were examined within three aspects of social reference: authority-derived, self-derived, and peer-derived. Each aspect was scaled for complexity into six anchored levels. RESULTS: The levels of all three aspects correlated positively with conceptualization stages as well as with each other. When the covariate, age, was taken into consideration, peer-derived valuation was significantly correlated with both age and stage. CONCLUSIONS: Moral valuation is a domain of conscience functioning in which moral rules and their justifications are socially referenced in relationship to authority, self, and peers. Anchored levels of these three aspects of moral valuation provide developmental guidelines for mental status examinations in patients between 5 and 17 years of age as well as providing criteria for future comparative studies in various diagnostic categories of psychopathology.

Adolescent↗
PubMed1994

Patterns of symptomatic recovery in psychotherapy.

Using the psychotherapy dosage model in which effect was probability of recovery, this study compared treatment response rates for psychological symptoms. Symptom checklists were administered to 854 psychotherapy outpatients at intake and during treatment. Sixty-two symptoms were grouped into 3 classes on the basis of probit analysis results. Chronic distress symptoms demonstrated the fastest average response rate, whereas characterological symptoms demonstrated the slowest. Acute distress symptoms showed the highest average percentage of patients recovered across doses. A typical outpatient needed about a year of psychotherapy to have a 75% chance of symptomatic recovery. The model holds promise for establishing guidelines for the financing of psychotherapy.

Adolescent↗
PubMed1994

Moral-emotional responsiveness: a two-factor domain of conscience functioning.

OBJECTIVE: The purpose of this study was to assess the progression in development of moral-emotional responsiveness in children and adolescents and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. METHOD: Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed regarding comprehension of their emotional responses to moral stimuli. RESULTS: Rational analysis of the responses identified six items; each item was scaled for complexity into five stages. Factor analysis of the six items revealed two factors: moral-emotional responsiveness 1 contained items relating to external anxiety, internal anxiety, and mood; more-emotional responsiveness 2 contained items relating to the restoration of psychophysiological equilibrium through the processes of reparation and healing. Differences between conceptualization stages, with the moral-emotional responsiveness factors serving as dependent variables, were accounted for by stage differences in age and the positive correlations between the moral-emotional responsiveness factors and age. CONCLUSIONS: Moral-emotional responsiveness is a two-factor domain of the conscience. The findings provide additional developmental guidelines for assessing conscience development and functioning both in clinical practice and in research.

Adolescent↗
PubMed1991

Conceptualization of conscience in normal children and adolescents, ages 5 to 17.

In order to determine how normal children and adolescents conceptualize their conscience, the Stilwell Conscience Interview was given to 125 normal subjects between the ages of 5 and 17. Responses to questions 1, 2 and 11 (including the drawing of conscience) were empirically analyzed, resulting in a five-stage developmental model. The responses were then randomly presented to two blinded raters to assign them to one of the five stages. Highly acceptable interrater reliability was found, Kappa = 0.90. The relationship of age to stage demonstrated a highly significant positive correlation, indicating that the conceptualization of conscience in normal development follows an invariant, hierarchical pattern of organization. A commentary regarding each stage is presented. The value of this conceptualization model as a comparative standard of normality in the clinical assessment of youngsters suffering from psychopathology is discussed relative to assessment, psychotherapy, and future research.

Adolescent↗