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PubMed1984

Antecedent and attendant stimuli in smoking: implications for behavioral maintenance and modification.

Considerable research exists on biological and psychological explanations for smoking and evaluations of interventions. This research, which supports a psychological model of smoking maintenance, identified situations commonly associated with smoking and noted implications for intervention. College student (N = 34) and general public (N = 48) men and women smokers were questioned about the frequency, onset age, and daily situations associated with their habit. No sex differences were found in either sample for responses, and correlations between smoking rate and onset age or years of smoking were not significant. Chi-square analysis indicated significant differences between samples in frequency with which common situational stimuli were associated with smoking. This behavior may be maintained as functionally autonomous, and effective intervention must sensitize smokers to elicitive situational stimuli as well as the smoking response.

Adult↗
PubMedDate not supplied

[Psychology and the cancer patient].

Over the past thirty years, an abundant international production has been generated on the subject of this paper. Papers may be subdivided into two main streams, one with an assistential bent and the other psychosomatic. In its turn, the latter takes in certain studies relating to a psychological model and another group of writings is oriented in accordance with psychodynamic principles. Both aim to evidence a certain correlation between physical and mental phenomena. Psychobiological theories aim to provide a model of correlation between the set of psychophysiological phenomena known as stress and cancer, while the psychodynamic view proposes a correlation between cancer and the individual personality; specifically, the theories set out to explain how the personality structure of a number of individuals leads to their managing stress anomalously with the result that stress is involved in the development of cancer along with genetic and environmental factors. Within this latter context, a number of workers have defined typical anamnestic profiles on the basis of the evolution of such personalities. The present study concerns 44 cases used to examine the orientation of the international literature, above all for the purpose of elaborating psychotherapeutic techniques possibly working in synergy with medical techniques in the treatment of some of these patients.

Female↗
PubMed2000

Cognitive vulnerability in patients with bipolar disorder.

BACKGROUND: No study has simultaneously explored key components of Beck's model of cognitive vulnerability to depression in people with bipolar disorders. METHODS: We compared 41 euthymic bipolar patients with 20 healthy control subjects. All subjects were assessed on the Hamilton Rating Scale for Depression, the Autobiographical Memory Test and the Mean Ends Problem-Solving procedure and also completed the Beck Depression Inventory, the Dysfunctional Attitude Scale, the Sociotropy Autonomy Scale and the Rosenberg Self-Esteem Questionnaire. RESULTS: In comparison to control subjects, patients with bipolar disorder demonstrated significantly higher levels of dysfunctional attitudes (particularly perfectionism and need for approval) and sociotropy, significantly greater over-general recall on an autobiographical memory test and significantly less ability to generate solutions to social problem-solving tasks. These between group differences remained significant when age, intelligence, latency to respond to autobiographical memory test cue words, and subjective mood ratings were included as co-variates in the statistical analysis. Within the patient group, cognitive dysfunction was significantly correlated with level of morbidity (as measured by number of previous illness episodes). CONCLUSIONS: This study suggests that cognitive vulnerability in patients with bipolar disorder is similar to that described in unipolar disorders. It is not clear whether this dysfunction is a cause or an effect of repeated episodes of bipolar disorder. However, the findings may have implications for clinical treatment as well as suggesting a number of important new avenues of research into psychological models of affective disorder.

Adult↗
PubMed2001

Empathy from a nursing perspective: Moving beyond borrowed theory.

Empathy is a concept deeply rooted in and central to professional nursing. Although viewed as an important concept, little consensus exists in the professional literature about either the definition or the application of the concept to nursing practice. This article will compare two theories of empathy, one borrowed from Kohut's self-psychology model and one derived from King's Interacting Systems nursing framework. The two theories are examined to clarify issues pertaining to the concept of empathy and to identify the contributions and limitations of borrowed theory as the basis for nursing practice. The article explores similarities and difference in the two views of empathy and highlights the necessity of developing nursing science from theory based in nursing which reflects the very unique nature of nursing practice. Nursing as a profession is distinct and unique, and borrowed theory must be questioned for its fit and applicability to the profession. The article concludes that empathy is a nursing phenomenon needing to be studied from a nursing perspective. The results of continued use of borrowed theory pertaining to empathy is discussed including the delay and misdirection of ongoing activity to develop the concept of empathy.

Empathy↗
PubMed1989

Repressive coping style and anxiety in stressful dental surgery.

Elevated state-anxiety prior to oral surgery is common and is associated with increased post-operative pain. This paper presents a psychological model of predicting elevated anxiety prior to dental surgery. Elevated anxiety and intraoperative stress can be predicted by measuring trait-anxiety. However, prediction may be improved by using a situationally specific measure of trait-anxiety, and by taking the patient's coping style into account. Thirty-nine patients undergoing wisdom-tooth extraction took part in the study. The Corah Dental Anxiety Scale was a better predictor of pre-operative anxiety than the STAI trait-anxiety scale. Coping style was measured by means of the Marlowe-Crowne Social Desirability Scale in conjunction with scores on trait-anxiety to define three coping style groups: sensitizers (high-anxious), truly low-anxious, and repressors who verbally deny anxiety. Two oral surgeons rated patient intra-operative state on 100 mm visual analogue scales. These ratings indicate that 'repressors' exhibit significantly more stress responses than the truly low-anxious group, in spite of similar (low) trait-anxiety scores. It is concluded that a situationally specific measure of trait-anxiety is the most appropriate predictor of differential state-anxiety elevations prior to oral surgery. Repressive coping style may be a confounding factor, in terms of predicting elevated anxiety, since some people verbally deny being anxious but express it behaviourally.

Adolescent↗
PubMed2000

Assessing the significant others of chronic pain patients: the psychometric properties of significant other questionnaires.

Contemporary reviews of psychological models of chronic pain have favoured behavioural and cognitive-behavioural formulations. These have often assumed that pain behaviours are maintained by environmental reinforcers. One of the most commonly hypothesized sources of reinforcement has been patients' significant others. Further, it has often been recognized that significant others may also be affected by pain behaviours and that they may experience changes in their lifesyles and in their mood as a consequence of living with someone who has pain. Somewhat surprisingly, relatively little clinical research has been published investigating significant others and their relationships with pain patients. Among other things, one of the limiting factors has been the lack of measurement tools available for assessing the relevant variables thought to be important with regards to significant others (such as their responses to, and perceptions of, chronic pain). This study attempted to remedy this situation by developing and testing the psychometric properties of a number of questionnaires specifically designed for significant others of chronic pain patients. The questionnaires have been selected to assess both significant others' (behavioural and cognitive) responses to pain as well as the extent to which pain impacts on their lives. Although not all of the questionnaires were found to possess equally strong psychometric properties, the availability of several solid measures opens the way for more empirical analyses of significant others and their interactions with chronic pain patients.

Adaptation, Psychological↗
PubMed2005

Decision making and effort in the self-regulation of hypertension: testing two competing theories.

We compare the ability of two social psychological models to explain self-regulation decisions to control hypertension by 208 patients at a hospital clinic: the theory of planned behaviour (TPB) and the model of goal-directed behaviour (MGB). The sample was drawn from patients at a large research hospital in North America. The findings show that the MGB not only explains significantly more variance in decision making than the TPB, but it provides an account for how reasons for acting become integrated and transformed into intentions to act, which the TPB does not address. The MGB does this in part by introducing the variable, desire, as an essential mediator between reasons for acting and intentions. The MGB also incorporates the effects of anticipated emotions on decision making, which are forms of forward-looking counterfactual thinking with respect to goals. In addition, the present study reconceptualized instrumental behaviour to encompass how hard one tries to act in the senses of (1) devoting time to planning with respect to reducing/maintaining blood pressure, (2) expending mental/physical energy to reduce/maintain blood pressure, (3) maintaining will power to reduce/maintain blood pressure, and (4) sustaining self-discipline (e.g. in overcoming obstacles) to reduce/maintain blood pressure. Key differences, as well as commonalities, in decision making are pointed-out between men and women and between people whose goal is to reduce versus maintain blood pressure.

Adult↗
PubMed1999

The structure of common mental disorders.

BACKGROUND: This report presents the results of confirmatory factor analyses of patterns of comorbidity among 10 common mental disorders in the National Comorbidity Survey, a national probability sample of US civilians who completed structured diagnostic interviews. METHODS: Patterns of comorbidity among DSM-III-R mental disorders were analyzed via confirmatory factor analyses for the entire National Comorbidity Survey sample (N = 8098; age range, 15-54 years), for random halves of the sample, for men and women separately, and for a subsample of participants who were seeing a professional about their mental health problems. Four models were compared: a 1-factor model, a 2-factor model in which some disorders represented internalizing problems and others represented externalizing problems, a 3-factor variant of the 2-factor model in which internalizing was modeled as having 2 subfactors (anxious-misery and fear), and a 4-factor model in which the disorders represented separate affective, anxiety, substance dependence, and antisocial factors. RESULTS: The 3-factor model provided the best fit in the entire sample. This result was replicated across random halves of the sample as well as across women and men. The substantial empirical intercorrelation between anxious-misery and fear (0.73) suggested that these factors were most appropriately conceived as subfactors of a higher-order internalizing factor. In the treatment sample, the 2-factor model fit best. CONCLUSIONS: The results offer a novel perspective on comorbidity, suggesting that comorbidity results from common, underlying core psychopathological processes. The results thereby argue for focusing research on these core processes themselves, rather than on their varied manifestations as separate disorders.

Adolescent↗
PubMed2005

The structure of posttraumatic stress disorder: latent class analysis in 2 community samples.

CONTEXT: Latent structure analysis of DSM-IV posttraumatic stress disorder (PTSD) can help clarify how persons who experience traumatic events might be sorted into clusters with respect to their symptom profiles. Classification of persons exposed to traumatic events into clinically homogeneous groups would facilitate further etiologic and treatment research, as well as research on the relationship of trauma and PTSD with other disorders. OBJECTIVES: To examine empirically the structure underlying PTSD criterion symptoms and identify discrete classes with similar symptom profiles. DESIGN: Data on PTSD symptoms from trauma-exposed subsets of 2 community samples were subjected to latent class analysis. The resultant classes were studied in associations with trauma type and indicators of impairment. SETTING: The first sample is from the Detroit Area Survey of Trauma (1899 trauma-exposed respondents with complete data) and the second is from a mid-Atlantic study of young adults conducted by The Johns Hopkins University Prevention Research Center, Baltimore, Md (1377 trauma-exposed respondents with complete data). PARTICIPANTS: Respondents in the 2 community samples who experienced 1 or more qualifying PTSD-level traumatic events. MAIN OUTCOME MEASURES: Number, size, and symptom profiles of latent classes. RESULTS: In both samples, analysis yielded 3 classes: no disturbance, intermediate disturbance, and pervasive disturbance. The classes also varied qualitatively, with emotional numbing distinguishing the class of pervasive disturbance, a class that approximates the subset with DSM-IV PTSD. Members of the pervasive disturbance class were far more likely to report use of medical care and disruptions in life or activities. CONCLUSIONS: The 3-class structure separates trauma-exposed persons with pervasive disturbance (a class that approximates DSM-IV PTSD) from no disturbance and intermediate disturbance, a distinction that also helps identify population subgroups with low risk for any posttrauma disturbance. The results suggest that the structure of PTSD is ordinal and configurational and that emotional numbing differentiates the class with pervasive disturbance. These results should motivate prospective research of persons who have experienced trauma to trace the emergence of posttrauma symptoms and the timing of emotional numbing relative to other symptoms.

Adult↗
PubMed2005

Categorical and continuous models of liability to externalizing disorders: a direct comparison in NESARC.

CONTEXT: Patterns of genetic, environmental, and phenotypic relationships among antisocial behavior and substance use disorders indicate the presence of a common externalizing liability. However, whether this liability is relatively continuous and graded, or categorical and class-like, has not been well established. OBJECTIVES: To compare the fit of categorical and continuous models of externalizing liability in a large, nationally representative sample. DESIGN: Categorical and continuous models of externalizing liability were compared using interview data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). SETTING: Face-to-face interviews conducted in the United States. PARTICIPANTS: Random sample of 43 093 noninstitutionalized adult civilians living in the United States. MAIN OUTCOME MEASURES: Lifetime and current (past 12 months) diagnoses of antisocial personality disorder, nicotine dependence, alcohol dependence, marijuana dependence, cocaine dependence, and other substance dependence. RESULTS: In the entire sample, as well as for males and females separately, using either lifetime or current diagnoses, the best-fitting model of externalizing liability was a continuous normal model. Moreover, there was a general trend toward latent trait models fitting better than latent class models, indicating that externalizing liability was continuous and graded, rather than categorical and class-like. CONCLUSIONS: Liability to externalizing spectrum disorders is graded and continuous normal in distribution. Research regarding etiology, assessment, and treatment of externalizing disorders should target externalizing liability over a range of severity. Current diagnoses represent extremes of this continuous liability distribution, indicating that conditions currently classified as subthreshold are likely to provide important information regarding liability to externalizing phenomena.

Adolescent↗
PubMed2006

Major depressive episodes and random mood.

CONTEXT: Mathematical models describing changes in mood in affective disorders may assist in the identification of underlying pathologic and neurobiologic mechanisms and in differentiating between alternative interpretations of psychiatric data. OBJECTIVE: Using time-to-event data from a large epidemiologic survey on recovery from major depression, to model the survival probability, in terms of an underlying process, with parameters which might be recognized and influenced in clinical practice. DESIGN: We present a sequential-phase model for survival analysis, which describes depression as a state with or without an additional incubation phase. Recovery is seen as the transition to a nondepressive state. We show that this sequential-phase model finds a microscopic realization in a dynamic description, the random-mood model, which depicts mood as governed by an Ornstein-Uhlenbeck type of stochastic process, driven by intermittent gaussian noise. RESULTS: For reversible depression (80%), the fractional probability of recovery is remarkably independent of the history of the depression. Analysis with the sequential-phase model suggests single exponential decay in this group, possibly with a short incubation phase. Within the random-mood model, the data for this reversibly depressed cohort are compatible with an intermittent noise pattern of stimuli with average spacing of 4 months and incompatible with nonintermittent noise. CONCLUSIONS: Time-to-event data from psychiatric epidemiologic studies can be conceptualized through modeling as intrasubject processes. The proposed random-mood model reproduces the time-to-event data and explains the incubation phase as an artifact due to the inclusion criterion of 14 days in most current psychiatric diagnostic systems. Depression is found to result more often from pileup of negative stimuli than from single life events. Time sequences, generated using the random-mood model, produce power plots, phase-space trajectories, and pair-correlation sums, similar to recent results for individual patients. This suggests possible clinical relevance along with the model's use as a tool in survival analysis.

Affect↗
PubMed1998

Can panic be induced in deep sleep? Examining the necessity of cognitive processing for panic.

This study examines the relative contribution of biological and psychological processes to the induction of panic attacks by a biochemical challenge agent. Panicogenic doses of caffeine were administered to 8 panic disorder (PD) patients and 11 healthy volunteers during stage 3-4 sleep, when cognitive processing is minimal and the threshold to external stimuli is high. Panic attacks were induced directly from sleep in 3 subjects and subclinical panics in an additional 3. Subjects who experienced full panic attacks spent periods of time ranging from 4 to 52 minutes in stage 2 sleep before awakening in a panic, while those who awakened in subclinical panic awakened almost directly from stage 4 sleep. PD patients experienced significantly more panic symptoms than healthy volunteers. Although limited by a small sample size, this study suggests a combined biological-psychological model of panic induction in which panic disorder patients are more biologically predisposed than healthy controls to panic symptoms but may require cognitive processing for the elaboration of a full panic attack.

Adolescent↗
PubMedDate not supplied

Patterns for the initiation of breastfeeding in humans.

Establishment of lactation has important biological and emotional health consequences for the newborn. Even so, substantial variation within a culture and among different cultures is seen in the onset of breastfeeding. Parametric mixture models are used to explore this variation and to uncover general human patterns for the initiation of breastfeeding. The model components reflect two hypothesized patterns of behavior. The first component is a "natural" pattern of breastfeeding that reflects, to some extent, a general mammalian behavior. The second component arises through culturally mediated behaviors that affect the initiation of breastfeeding. The model was fit by maximum likelihood to interval- and right-censored observations on 26220 mother-infant pairs collected from 25 previously published studies of breastfeeding behavior. Both model components were clearly statistically identified. Effects of cultural and geographic covariates were found to have significant effects on all components of the model. Although there is clear evidence for two distinct patterns of behavior in the initiation of breastfeeding, the results suggest that learned behaviors play an important role in mediating even "natural" breastfeeding behavior.

Breast Feeding↗
PubMed2006

Different results on tetrachorical correlations in Mplus and Stata--Stata announces modified procedure.

To identify the structure of mental disorders in large-scale epidemiological data sets, investigators frequently use tetrachoric correlations as a first step for subsequent application of latent class and factor analytic methods. It has been possible to do this with Stata since 2005, whereas the corresponding Mplus routine has been on the market for some years. Using an identical data set we observed considerable differences between the results of the packages. This paper illustrates the differences with several examples from the Early Developmental Stages of Psychopathology Study data set, which consists of 3021 subjects, with diagnostic information assessed by the CIDI. Results reveal that tetrachoric correlations resulting from Mplus were often considerably smaller than those computed with Stata. The results were dramatically different, especially where there were few observation per cell or even empty cells. These findings were put to Mplus and Stata, whose responses clarified the discrepancies by describing the different mathematical assumptions and procedures used. Stata announced that it intended to launch a modified procedure.

Computer Simulation↗
PubMed2005

A multistate Markov chain model for longitudinal, categorical quality-of-life data subject to non-ignorable missingness.

Quality-of-life (QOL) is an important outcome in clinical research, particularly in cancer clinical trials. Typically, data are collected longitudinally from patients during treatment and subsequent follow-up. Missing data are a common problem, and missingness may arise in a non-ignorable fashion. In particular, the probability that a patient misses an assessment may depend on the patient's QOL at the time of the scheduled assessment. We propose a Markov chain model for the analysis of categorical outcomes derived from QOL measures. Our model assumes that transitions between QOL states depend on covariates through generalized logit models or proportional odds models. To account for non-ignorable missingness, we incorporate logistic regression models for the conditional probabilities of observing measurements, given their actual values. The model can accommodate time-dependent covariates. Estimation is by maximum likelihood, summing over all possible values of the missing measurements. We describe options for selecting parsimonious models, and we study the finite-sample properties of the estimators by simulation. We apply the techniques to data from a breast cancer clinical trial in which QOL assessments were made longitudinally, and in which missing data frequently arose.

Antineoplastic Agents↗
PubMed2000

The development of working memory: exploring the complementarity of two models.

The aim of the paper was to further explore the complementarity of the working memory models postulated by Pascual-Leone and Baddeley. Five-, six-, eight-, and nine-year-old children were assessed on two working memory tasks that have frequently been used within the respective streams of research: the Mr. Peanut task and the Corsi blocks task. Results indicated a developmental increase in spatial short-term memory for both tasks. Concurrent spatial suppression reduced performance on the two tasks in all four age groups. By contrast, articulatory suppression interfered with recall only on the Mr. Peanut task, and in only the older children. The two models were shown to make their own specific contribution to the interpretation of the data, attesting to their complementarity. Pascual-Leone's theory offered a clear explanation of the results concerning the central aspects of working memory, that is, the stepwise age-related increase in performance, whereas Baddeley's model provided a convincing account of the findings regarding the peripheral phonological and visuo-spatial components, that is, the effects of articulatory and spatial suppression.

Attention↗