Práticas avaliativas realizadas por psicólogos hospitalares: um estudo descritivo / Evaluative practices performed by health psychologists: a descriptive study / Prácticas evaluativas realizadas por psicólogos clínicos: un estudio descriptivo

As práticas avaliativas estão na gama de possibilidades de atuação do psicólogo no Hospital. Buscou-se investigar o manejo dos processos avaliativos por psicólogos hospitalares inseridos em hospitais não psiquiátricos, quanto aos tipos, origens, características e necessidades solicitadas, identificando a conduta destes frente às demandas. Foi conduzido estudo observacional descritivo, de corte transversal, com levantamento de dados multimétodos por meio de entrevista estruturada com 14 psicólogos hospitalares de Natal/RN. Entre os resultados, observou-se que 87,7% consideram avaliação descritiva como mais frequente, 78,6% percebem que estas acontecem tanto por solicitação da equipe quanto por identificação da necessidade pelo próprio psicólogo e verificou-se um predomínio do uso de técnicas qualitativas como avaliação. Concluiu-se que o ambiente hospitalar oferece desafios para um amplo uso das técnicas existentes que, juntamente com a escassez de material e recursos humanos, tem-se uma conjuntura desfavorável para o uso destas no Hospital. (AU)

Evaluative practices are among the possibilities of a psychologist's work at the Hospital. The aim was to investigate the management of the evaluation processes by hospital psychologists working in non-psychiatric hospitals, regarding the types, characteristics and needs requested, identifying their actions faced with the demands. A cross-sectional, descriptive and observational study was conducted with multi-method data collection through a structured interview with 14 hospital psychologists from Natal/RN. Among the results, 87.7% considered the descriptive evaluation to be the most frequent, 78.6% perceived that these occur due to requests of the team and identification of the need by the psychologists themselves, with a predominance of the use of qualitative techniques in the evaluation. It was concluded that the hospital environment presents challenges for a wide use of the existing techniques, which together with the scarcity of material and human resources present unfavorable conditions for the use of those practices in the Hospital. (AU)

Las prácticas evaluativas se encuentran dentro del abanico de posibilidades de actuación del psicólogo en el ámbito hospitalario. Se buscó investigar la gestión de los procesos de evaluación por psicólogos clínicos insertados en hospitales no psiquiátricos, con respecto a los tipos, orígenes característicos y necesidades solicitadas, identificando la conducta de los psicólogos ante las demandas. Se realizó un estudio observacional descriptivo, de corte transversal, con levantamiento de datos multimétodos a través de una entrevista estructurada con 14 psicólogos clínicos hospitalarios de la ciudad de Natal, Río Grande do Norte. Entre los resultados, se observó que el 87,7% considera la evaluación descriptiva como la más frecuente, el 78,6% afirma que estas ocurren tanto por solicitud del equipo como por el propio psicólogo al identificar la necesidad, verificando un predominio del uso de técnicas cualitativas como evaluación. Se concluyó que el entorno hospitalario presenta desafíos para un amplio uso de las técnicas existentes, que junto con la escasez de recursos materiales y humanos, se da una coyuntura desfavorable para el uso de las mismas en el hospital. (AU)

Why Digital Tools Have Not Yet Revolutionized Adolescent Health Research and What We Can Do.

The promise of digital tools and devices for spurring new discoveries in adolescence research is enticing. Notably, this special section draws attention to many of the advantages that mobile and wearable devices offer for ambulatory assessment research, which have now been realized. Despite such progress, digital tools have not yet delivered on their predicted revolution of adolescent health research. I offer four reasons for why digital devices have fallen short of this predicted promise. For each barrier, I suggest parallel strategies for ensuring adolescent research benefits from Ambulatory Assessment advances. To avoid being left behind, adolescence scholarship must develop in time with innovations in digital devices and platforms, which are moving forward to support basic science and interventions in mental health.

A Review of Current Ambulatory Assessment Studies in Adolescent Samples and Practical Recommendations.

The use of ambulatory assessment (AA) and related methods (experience sampling, ecological momentary assessment) has greatly increased within the field of adolescent psychology. In this guide, we describe important practices for conducting AA studies in adolescent samples. To better understand how researchers have been implementing AA study designs, we present a review of 23 AA studies that were conducted in adolescent samples from 2017. Results suggest that there is heterogeneity in how AA studies in youth are conducted and reported. Based on these insights, we provide recommendations with regard to participant recruitment, sampling scheme, item selection, power analysis, and software choice. Further, we provide a checklist for reporting on AA studies in adolescent samples that can be used as a guideline for future studies.

The Practicalities and Perils of Ambulatory Assessment's Promise: Introduction to a Special Section.

Ambulatory assessment (AA) offers one of the most exciting approaches for opening the dynamic "black box" of adolescents' daily lives. In this introduction, we spotlight AA's surprisingly restricted market share within adolescent scholarship. We describe thorny challenges these intense methods can pose when conducting adolescent research "in situ" and underscore that capturing quality AA data means placing adolescents' developmental stage at the forefront. The novel research reported in this special section speaks to these challenges and underscores the promise of AA for conducting developmentally salient science. The nine articles included in the section span multiple disciplines (Sociology, Psychology, Public Health) and reflect diverse viewpoints, approaches, and theories. All provide multiple novel best-practice strategies for conducting AA scholarship with adolescents.

Ambulatory Assessment of Adolescent Coping: It's a Complicated Process.

Scholars have long-called for researchers to treat coping as a process that is measured over an arc of time. Ambulatory assessment (AA) offers an appealing tool for capturing the dynamic process of adolescent coping. However, challenges in capturing the coping process are not altogether circumvented with AA designs. We conducted a scoping review of the AA literature on adolescent coping and draw from 60 studies to provide an overview of the field. We provide critiques of different AA approaches and highlight benefits and costs associated with various types of measurement within AA. We also speak to considerations of participant burden and compliance. We conclude with recommendations for developmental scholars seeking to deploy AA to capture this quintessential process among adolescents.

Measuring the Psychobiological Correlates of Daily Experience in Adolescents.

Mapping the psychobiological correlates of social contexts, experiences, and emotional responses of adolescents in their daily lives provides insight into how adolescent well-being shapes, and is shaped by, experience. Measures of these psychobiological correlates are enabled by devices and technologies that must be precise and suitable for adolescent participants. The present report reviews the most often used research measures, and suggests strategies for best practice, drawn from practical experience. The rapid advances in technological methods to collect attuned measures of psychological processes, social context, and biological function indicate the promise for multimodal measures in ecological settings. Attaining these methodological goals will support research to secure comprehensive, quality data, and advance the understanding of psychobiological function in ambulatory settings.

Older Adolescents' Understanding of Participant Rights in the BlackBerry Project, a Longitudinal Ambulatory Assessment Study.

For a long-term, longitudinal study that used BlackBerry smartphones for passive ambulatory assessment among older adolescents, this study focused on three areas of ethical concern: (1) adolescents' competence to give assent; (2) understanding of confidentiality, the protection of information, and project goals; and (3) awareness of procedures and benefits, and comfort with the research design. One hundred and seventy-eight participants were 17 and 18 years old (84 girls). Results suggested that participants freely gave consent and understood most, but not all of the informed consent information. Participants reported a high level of satisfaction. Participants showed less understanding of when their confidentiality would be broken and how data would be protected.

Picture my well-being: Listening to the voices of students with autism spectrum disorder.

BACKGROUND: Student well-being, though widely researched, continues to be a poorly defined concept. Few student well-being studies focus on students with autism spectrum disorder (ASD), who may have a poorer sense of well-being compared to typically developing students. AIMS: The current study aims to explore the conceptualisation, barriers, and ways to enhance the well-being of students with ASD from their perspectives. METHODS AND PROCEDURES: Photovoice, a participatory research method was used to elicit the views of 16 high school students with ASD to explore the concept of well-being. Data analysis was conducted using a grounded theory approach. OUTCOMES AND RESULTS: Students conceptualised well-being as multidimensional, identified sensory barriers, social barriers, and barriers that were associated with learning, and several external and internal assets that could support their well-being. CONCLUSIONS AND IMPLICATIONS: To promote well-being, barriers should be mitigated, while external and internal assets developed. Researchers should also consider the use of Photovoice to enable students' meaningful participation in research studies.

AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial.

BACKGROUND: A quarter of people with psychotic conditions experience persistent auditory verbal hallucinations, despite treatment. AVATAR therapy (invented by Julian Leff in 2008) is a new approach in which people who hear voices have a dialogue with a digital representation (avatar) of their presumed persecutor, voiced by the therapist so that the avatar responds by becoming less hostile and concedes power over the course of therapy. We aimed to investigate the effect of AVATAR therapy on auditory verbal hallucinations, compared with a supportive counselling control condition. METHODS: We did this single-blind, randomised controlled trial at a single clinical location (South London and Maudsley NHS Trust). Participants were aged 18 to 65 years, had a clinical diagnosis of a schizophrenia spectrum (ICD10 F20-29) or affective disorder (F30-39 with psychotic symptoms), and had enduring auditory verbal hallucinations during the previous 12 months, despite continued treatment. Participants were randomly assigned (1:1) to receive AVATAR therapy or supportive counselling with randomised permuted blocks (block size randomly varying between two and six). Assessments were done at baseline, 12 weeks, and 24 weeks, by research assessors who were masked to therapy allocation. The primary outcome was reduction in auditory verbal hallucinations at 12 weeks, measured by total score on the Psychotic Symptoms Rating Scales Auditory Hallucinations (PSYRATS-AH). Analysis was by intention-to-treat with linear mixed models. The trial was prospectively registered with the ISRCTN registry, number 65314790. FINDINGS: Between Nov 1, 2013, and Jan 28, 2016, 394 people were referred to the study, of whom 369 were assessed for eligibility. Of these people, 150 were eligible and were randomly assigned to receive either AVATAR therapy (n=75) or supportive counselling (n=75). 124 (83%) met the primary outcome. The reduction in PSYRATS-AH total score at 12 weeks was significantly greater for AVATAR therapy than for supportive counselling (mean difference -3·82 [SE 1·47], 95% CI -6·70 to -0·94; p<0·0093). There was no evidence of any adverse events attributable to either therapy. INTERPRETATION: To our knowledge, this is the first powered, randomised controlled trial of AVATAR therapy. This brief, targeted therapy was more effective after 12 weeks of treatment than was supportive counselling in reducing the severity of persistent auditory verbal hallucinations, with a large effect size. Future multi-centre studies are needed to establish the effectiveness of AVATAR therapy and, if proven effective, we think it should become an option in the psychological treatment of auditory verbal hallucinations. FUNDING: Wellcome Trust.

CFS MATLAB toolbox: An experiment builder for continuous flash suppression (CFS) task.

CFS toolbox is an open-source collection of MATLAB functions that utilizes PsychToolbox-3 (PTB-3). It is designed to allow a researcher to create and run continuous flash suppression experiments using a variety of experimental parameters (i.e., stimulus types and locations, noise characteristics, and experiment window settings). In a CFS experiment, one of the eyes at a time is presented with a dynamically changing noise pattern, while the other eye is concurrently presented with a static target stimulus, such as a Gabor patch. Due to the strong interocular suppression created by the dominant noise pattern mask, the target stimulus is rendered invisible for an extended duration. Very little knowledge of MATLAB is required for using the toolbox; experiments are generated by modifying csv files with the required parameters, and result data are output to text files for further analysis. The open-source code is available on the project page under a Creative Commons License ( http://www.mikkonuutinen.arkku.net/CFS_toolbox/ and https://bitbucket.org/mikkonuutinen/cfs_toolbox ).

The Promise and the Challenge of Technology-Facilitated Methods for Assessing Behavioral and Cognitive Markers of Risk for Suicide among U.S. Army National Guard Personnel.

Suicide was the 10th leading cause of death for Americans in 2015 and rates have been steadily climbing over the last 25 years. Rates are particularly high amongst U.S. military personnel. Suicide prevention efforts in the military are significantly hampered by the lack of: (1) assessment tools for measuring baseline risk and (2) methods to detect periods of particularly heightened risk. Two specific barriers to assessing suicide risk in military personnel that call for innovation are: (1) the geographic dispersion of military personnel from healthcare settings, particularly amongst components like the Reserves; and (2) professional and social disincentives to acknowledging psychological distress. The primary aim of this paper is to describe recent technological developments that could contribute to risk assessment tools that are not subject to the limitations mentioned above. More specifically, Behavioral Signal Processing can be used to assess behaviors during interaction and conversation that likely indicate increased risk for suicide, and computer-administered, cognitive performance tasks can be used to assess activation of the suicidal mode. These novel methods can be used remotely and do not require direct disclosure or endorsement of psychological distress, solving two challenges to suicide risk assessment in military and other sensitive settings. We present an introduction to these technologies, describe how they can specifically be applied to assessing behavioral and cognitive risk for suicide, and close with recommendations for future research.

[Online Counselling: The prospect of a therapeutic connection].

Over the last few years, Internet has become an integral part of daily life. An abundant source of information and a principal gateway of communication between individuals, Internet has been continuously gaining considerable ground as a tool of awareness and intervention in the area of public health. With regard to the field of mental health, Internet exhibits a credible potential in facilitating dialogue not only between experts and their beneficiaries but also between stakeholders. Moreover and with regard to various aspects of public concern, it can serve as a circulation portal of educational material between students and teachers. The advent of remote support services dates back in the decade of 1970-1980. In the present time, they consist of informative guides and self-help groups or online counselling. The latter is defined as the process in which both parties, namely the therapist and the client, are involved in an oral or written conciliation through means of an internet connection, videoconferencing, live chat or e-mail exchange. The benefits of this practice - accessibility, relocation, convenience, anonymity, facilitation of face-to-face psychotherapy and low cost - could make online counseling, in specific cases, the treatment of choice. While the usage of the World Wide Web seems promising for the rectification of mental health disorders, there is some debate among experts regarding the ethical aspect of practicing psychotherapy in an interactive digital environment. Issues such as technical expertise and the tackling of related problems, difficulties in the diagnostic process, interchange of verbal and nonverbal cues, crisis management, safeguarding the therapeutic alliance, protection of personal data, age restriction, keeping boundaries in relation to the setting, the time and the dynamics of the therapeutic relationship and, finally, training and supervisory process of online therapist, are some subjects of disagreement. Relevant research reveals the effectiveness of online counseling in decreasing the magnitude of reported symptoms, with a direct positive impact on the improvement of daily functioning and on future relapses. However, the usefulness of developing a therapeutic relationship through internet connection is being criticized by a group of clinicians, with their main arguments revolving around spatiotemporal issues and the reliability of incoming information. Some other researchers correlate the therapeutic alliance concluded in the context of electronic communication with a positive therapeutic effect. The data on the effectiveness of online practice are not sufficient to draw a definite conclusion. In an era of direct and rapid communication, it is imperative to encourage further research, for the determination of optimal conditions with respect to the practice of internet-delivered psychotherapy and the patients' well being as a result of treatment.

Attention! A good bedside test for delirium?

BACKGROUND: Routine delirium screening could improve delirium detection, but it remains unclear as to which screening tool is most suitable. We tested the diagnostic accuracy of the following screening methods (either individually or in combination) in the detection of delirium: MOTYB (months of the year backwards); SSF (Spatial Span Forwards); evidence of subjective or objective 'confusion'. METHODS: We performed a cross-sectional study of general hospital adult inpatients in a large tertiary referral hospital. Screening tests were performed by junior medical trainees. Subsequently, two independent formal delirium assessments were performed: first, the Confusion Assessment Method (CAM) followed by the Delirium Rating Scale-Revised 98 (DRS-R98). DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria were used to assign delirium diagnosis. Sensitivity and specificity ratios with 95% CIs were calculated for each screening method. RESULTS: 265 patients were included. The most precise screening method overall was achieved by simultaneously performing MOTYB and assessing for subjective/objective confusion (sensitivity 93.8%, 95% CI 82.8 to 98.6; specificity 84.7%, 95% CI 79.2 to 89.2). In older patients, MOTYB alone was most accurate, whereas in younger patients, a simultaneous combination of SSF (cut-off 4) with either MOTYB or assessment of subjective/objective confusion was best. In every case, addition of the CAM as a second-line screening step to improve specificity resulted in considerable loss in sensitivity. CONCLUSIONS: Our results suggest that simple attention tests may be useful in delirium screening. MOTYB used alone was the most accurate screening test in older people.

Disrupted theory of mind network processing in response to idea of reference evocation in schizophrenia.

OBJECTIVE: This study examined the neural pathophysiology of the theory of mind network by eliciting self-referential processing during an idea of reference evocating situation in patients with schizophrenia. METHOD: Functional MRI was conducted on 14 schizophrenic in-patients with the idea of reference and 15 healthy participants while viewing video vignettes of referential conversations, non-referential conversations or no conversations between two people, which were filmed at varying distances of 1, 5 or 10 m. RESULTS: The patient group did not show normal patterns of superior temporal sulcus activation to conversational context, and reciprocal deactivation and activation of the ventromedial and dorsomedial prefrontal cortex to referential conversational context. Instead, the patient group showed overall greater ventromedial prefrontal activities across different conversational contexts and inverse correlation between superior temporal sulcus activity and delusional severity. Differential activations of the temporal pole and its posterior extension to varying distances were observed in the control group but not in the patient group. CONCLUSION: The present study demonstrates that theory of mind-related responses of the medial prefrontal-superior temporal network are attenuated during the self-referential processing in patients with schizophrenia and that these abnormalities may be related to the formation of their referential or persecutory delusion.

Utilizing Ecological Momentary Assessment in pediatric obesity to quantify behavior, emotion, and sleep.

This study examined the feasibility of using Ecological Momentary Assessment (EMA) to examine important domains relevant to interregulatory health processes in overweight adolescent females in their natural environments. Participants were 20 overweight adolescent females engaged in a cognitive-behavioral and motivational interviewing intervention aimed at weight loss and improving mood (11-19 years old, 80% white, 15% African American, mean BMI = 39). During this EMA protocol, participants were asked to report their physical activity (PA), nutrition, mood, and sleep during 14 cellular phone calls over three extended weekends (Thursday to Monday). Simultaneously, participants wore an actigraph (armband and watch communicator) that provided instantaneous PA feedback (steps taken and kilocalories) and sleep parameters (duration and efficiency). EMA compliance rates for the armband and phone calls were 74.7 +/- 0.3% and 64.2 +/- 0.3%, respectively. Data from the armband and phone calls are presented to illustrate the depth of information acquired by utilizing this innovative methodology.

A new method to assess perceived well-being among elderly people--a feasibility study.

BACKGROUND: A simple but countable electronic device has been developed to gain reliable information on elderly patients' perceived well-being. The device has been tested and proven to be technically functional and countable. It was now tested in two care homes for the elderly and two private homes to evaluate if it provided solid information about the well-being of elderly persons. This report illustrates the practical usage of the device and shows its efficiency in gathering solid well-being information from the focus group. METHODS: The test arrangement was carried out by assigning a group of volunteers (n = 10) in care homes for the elderly for two weeks. The time period was long enough to collect a sufficient amount of information to evaluate the perceived well-being of the test subjects. Perceived well-being was assessed by using a Con-Dis device and by filling out an attached questionnaire - RAI - at the same time. RAI consisted of questions concerning mood, pain and quality of life. A standardised RAVA questionnaire with 12 questions concerning test subject's health was also answered once during the two-week time period by each test subject. After the test period the data obtained by Con-Dis was compared with the findings collected using questionnaires. RESULTS: A statistically significant correlation was found between perceived well-being (measured by Con-Dis) and questionnaire-based mood (r = 0,66, Pearson Correlation Coefficient) and quality of life (r = 0,68). No statistically significant correlation was found between perceived well-being and pain (r = 0,28). Technical functionality and feasibility of Con-Dis were good during the test period. Some problems arose because the test subjects were elderly and some in poor physical condition. CONCLUSION: On the basis of the collected results, the Con-Dis device presented information on the test subjects' perceived well-being that appeared to correlate with certain aspects of their health status. The test subjects' mood and quality of life but not pain had a statistically significant association with the perceived well-being level measured by Con-Dis.

Mild traumatic brain injury and its sequelae: characterisation of divided attention deficits.

Deficits in divided attention occur after a mild traumatic brain injury (MTBI) but many extant tasks lack sensitivity for detecting subtle cognitive difficulties. We use the Test d'Attention Partagee Informatise (TAPI), a novel dual-task paradigm, to investigate the impact of MTBI on the ability to divide attention between two stimuli sources. Individuals with MTBI (n=37) were evaluated within the first week following head trauma and at three months post-injury. A healthy control (HC) group (n=79) was also assessed. The primary outcome was reaction time and there were three different conditions that included visual target detection and auditory digit span tasks. Analyses utilised repeated measures ANOVA and ANCOVA models that adjusted for relevant variables including post-concussive and affective symptoms. Results indicated that at both baseline and follow-up, the MTBI group had significantly slower reaction time than the HC group. Also, both the MTBI and HC groups had slower reaction times as participants progressed through each of the more challenging TAPI conditions. This study supports the usefulness of this novel instrument and allows clinicians and researchers to assess for subtle divided attention deficits that may persist in those with MTBI even three months post-injury.

Techniques and devices to restore cognition.

Executive planning, the ability to direct and sustain attention, language and several types of memory may be compromised by conditions such as stroke, traumatic brain injury, cancer, autism, cerebral palsy and Alzheimer's disease. No medical devices are currently available to help restore these cognitive functions. Recent findings about the neurophysiology of these conditions in humans coupled with progress in engineering devices to treat refractory neurological conditions imply that the time has arrived to consider the design and evaluation of a new class of devices. Like their neuromotor counterparts, neurocognitive prostheses might sense or modulate neural function in a non-invasive manner or by means of implanted electrodes. In order to paint a vision for future device development, it is essential to first review what can be achieved using behavioral and external modulatory techniques. While non-invasive approaches might strengthen a patient's remaining intact cognitive abilities, neurocognitive prosthetics comprised of direct brain-computer interfaces could in theory physically reconstitute and augment the substrate of cognition itself.

Stability of negative self-structures: a longitudinal comparison of depressed, remitted, and nonpsychiatric controls.

To be considered a vulnerability marker for depression, a variable should, in addition to demonstrating sensitivity and specificity, also show evidence of temporal stability (i.e., remain present in the absence of depressive symptomatology). Although many cognitive factors are associated with depression, the majority of them appear to be episode rather than vulnerability markers. This study examined cognitive organization of positive and negative interpersonal and achievement content in clinically depressed, remitted, and nonpsychiatric controls. At initial assessment, a sample of 54 clinically depressed individuals and 37 never-depressed controls completed self-report measures of positive and negative automatic thoughts and two cognitive organizational tasks. They were retested 6 months later when half of the depressed group no longer met diagnostic criteria for major depression. Negative automatic thoughts decreased and positive automatic thoughts increased significantly in individuals who had improved clinically. The organization of negative interpersonal content remained stable despite symptom amelioration, but negative achievement content was less interconnected at follow-up in those patients who had improved. The structure of relational schemas, in particular, appears to be stable and may be an important cognitive vulnerability factor for depression.