Life Program: Pilot Testing a Palliative Psychology Group Intervention.

BACKGROUND: Psychosocial interventions for palliative care populations, individuals with life-limiting illness, improve distress; however, less is known about these interventions among military Veterans. OBJECTIVES: This quality improvement project evaluated a palliative psychology group intervention to reduce depression, anxiety, and stress among Veterans with advanced life-limiting illness. METHODS: Veterans receiving palliative care at a mid-Atlantic VA healthcare system were referred by a mental health provider. The group intervention was delivered face-to-face in six to eight weekly sessions, with groups of four to eight participants. The intervention (Life Program), was a hybrid of cognitive-behavioral therapy and acceptance and commitment therapy that targeted: personal values, mindfulness, and psychological flexibility. A single-arm pre-post-test design was used to assess depression, anxiety, and stress, and satisfaction with the intervention. RESULTS: Seventy-five percent (39/52) of all Veterans who were contacted expressed interest and agreed to participate. Seventeen of 39 enrolled Veterans completed all sessions. The mean age of participants who completed the program was 63.06 (standard deviation = 8.47). Most participants were male (88%), Caucasian (58%), and had a cancer diagnosis (65%). Mean pre-post reductions in depression (18.82 vs. 13.20), anxiety (16.59 vs. 14.59), stress (19.18 vs. 13.88), and psychological inflexibility were observed. Mean differences in symptom severity were clinically meaningful. Barriers to feasibility included transportation issues and illness burden. CONCLUSIONS: Veterans who completed all sessions of a palliative psychology group intervention had reductions in depression, anxiety, and stress. Estimates of the treatment effects may be inflated using completer data alone. Further research is needed to inform ways to improve program engagement and adherence and examine efficacy in Veterans with advanced life-limiting illness.

Psychotherapy Targeting Depression and Anxiety for Use in Palliative Care: A Meta-Analysis.

BACKGROUND: Research on the effectiveness of evidence-based practices in the treatment of depression and anxiety with palliative care populations is primarily limited to individuals having specific conditions such as cancer. OBJECTIVE: This meta-analysis examined the effect of psychotherapy on depression and anxiety among individuals with any condition appropriate for palliative care. METHODS: We searched PubMed, PsycINFO, Cochrane Library, and EMBASE databases until August 2017. Eligible studies were randomized controlled trials of psychotherapy that reported outcomes of depression and anxiety and included adults with serious illnesses. RESULTS: The current meta-analysis included 32 randomized controlled trials with 36 samples including 1536 participants undergoing psychotherapy. Overall, findings suggest that psychotherapy in palliative care populations reduced depression (large effect) and anxiety (small effect) symptoms. Psychotherapy also improved quality of life (small effect). Significant moderators of intervention effects included type of intervention and provider, number and length of treatment sessions, and sample age. Cognitive-behaviorally based and other therapies (e.g., acceptance, mindfulness) showed significant effects, as did interventions delivered by mental health providers. More treatment sessions were associated with greater effect sizes; longer sessions were associated with decreased effect sizes. As the sample age increased, the study effect size decreased. CONCLUSION: Findings suggest that psychotherapy for individuals with serious illnesses appropriate for palliative care can mitigate symptoms of depression and anxiety and improve quality of life. Methodological reporting and quality of research designs in studies of psychotherapy for palliative patient populations could be improved. Future research is needed with a broader range of patient populations.

The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: a meta-analysis.

Literature on posttraumatic stress disorder (PTSD) prevalence among Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans report estimates ranging from 1.4% to 60%. A more precise estimate is necessary for projecting healthcare needs and informing public policy. This meta-analysis examined 33 studies published between 2007 and 2013 involving 4,945,897 OEF/OIF veterans, and PTSD prevalence was estimated at 23%. Publication year and percentage of Caucasian participants and formerly active duty participants explained significant variability in prevalence across studies. PTSD remains a concern for a substantial percentage of OEF/OIF veterans. To date, most studies have estimated prevalence among OEF/OIF veterans using VA medical chart review. Thus, results generalize primarily to the prevalence of PTSD in medical records of OEF/OIF veterans who use VA services. Additional research is needed with randomly selected, representative samples administered diagnostic interviews. Significant financial and mental health resources are needed to promote recovery from PTSD.

The contribution of health anxiety to retrospectively-recalled emergency department visits within a sample of patients in residential substance abuse treatment.

With the burden of emergency department (ED) use increasing, research examining the factors associated with ED visits among individuals who use the ED most frequently is needed. Given that substance use is strongly linked to ED visits, this study sought to examine the factors associated with greater ED visits among patients with substance use disorders (SUD). More precisely, we examined whether health anxiety incrementally contributes to the prediction of ED visits for medical care among adult patients (N = 118) in a residential substance abuse disorder treatment facility. As predicted, health anxiety was significantly positively correlated with ED visits during the past year. Furthermore, health anxiety remained a significant predictor of ED visits after accounting for sociodemographic variables, frequency of substance use, and physical health status. These results suggest that health anxiety may contribute to increased ED visits for medical care among individuals with SUD.

Diagnostic efficiency of the AUDIT-C in U.S. veterans with military service since September 11, 2001.

BACKGROUND: Alcohol screening with the 3-item alcohol use disorders identification test (AUDIT-C) has been implemented throughout the U.S. Veterans Health Administration. Validation of the AUDIT-C, however, has been conducted with samples of primarily older veterans. This study examined the diagnostic efficiency of the AUDIT-C in a younger cohort of veterans who served during Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). METHODS: Veteran participants (N=1775) completed the alcohol use disorders identification test (AUDIT) and underwent the structured clinical interview for DSM-IV-TR for Axis I disorders (SCID) in research settings within four VA medical Centers. Areas under receiver operating characteristic curves (AUCs) measured the effiency of the full AUDIT and AUDIT-C in identifying SCID-based diagnoses of past year alcohol abuse or dependence. RESULTS: Both measures performed well in detecting alcohol use disorders. In the full sample, the AUDIT had a better AUC (.908; .881-.935) than the AUDIT-C (.859; .826-.893; p<.0001). It is notable that this same result was found among men but not women, perhaps due to reduced power. Diagnostic efficiency statistics for the AUDIT and AUDIT-C were consistent with results from older veteran samples. The diagnostic efficiency of both measures did not vary with race or age. CONCLUSIONS: Both the AUDIT and AUDIT-C appear to be valid instruments for identifying alcohol abuse or dependence among the most recent cohort of U.S. veterans with service during OEF/OIF within research settings.

Lead and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms: a meta-analysis.

This meta-analysis examined the association between Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms and lead exposure in children and adolescents. Thirty-three studies published between 1972 and 2010 involving 10,232 children and adolescents were included. There was a small to medium association between inattention symptoms and lead exposure (r=.16, k=27, p<.001) and a similar association between hyperactivity/impulsivity symptoms and lead exposure (r=.13, k=23, p<.001). There was significant heterogeneity among the effect sizes for both inattention symptoms and for hyperactivity/impulsivity symptoms, with studies using hair analysis to assess lead burden yielding substantially larger effect sizes than those using other methods. Excluding the hair analysis studies, the average rs were .14 for inattention (k=23, p<.001) and .12 for hyperactivity/impulsivity (k=21, p<.001). Overall, the relation between lead exposure and ADHD symptoms was similar in magnitude to the relation between lead exposure and decreased IQ and between lead exposure and conduct problems.

The two-factor model of psychopathic personality: evidence from the psychopathic personality inventory.

Psychopathy or psychopathic personality disorder represents a constellation of traits characterized by superficial charm, egocentricity, irresponsibility, fearlessness, persistent violation of social norms, and a lack of empathy, guilt, and remorse. Factor analyses of the Psychopathic Personality Inventory (PPI)typically yield two factors: Fearless Dominance (FD) and Self-Centered Impulsivity (SCI). Additionally, the Coldheartedness (CH) subscale typically does not load on either factor. The current paper includes a meta-analysis of studies that have examined theoretically important correlates of the two PPI factors and CH. Results suggest that (a) FD and SCI are orthogonal or weakly correlated, (b) each factor predicts distinct (and sometimes opposite) correlates, and (c) the FD factor is not highly correlated with most other measures of psychopathy. This pattern of results raises important questions about the relation between FD and SCI and the role of FD in conceptualizations of psychopathy. Our findings also indicate the need for future studies using the two-factor model of the PPI to conduct moderational analyses to examine potential interactions between FD and SCI in the prediction of important criterion measures.

Is it the inventory, the meta-analysis, or the construct? Reply to the comments on Marcus, Fulton, and Edens.

Replies to comments by Neumann et al. (see record 2013-01797-001), Patrick et al. (see record 2013-01797-002), Benning (see record 2013-01797-003), Lilienfeld (see record 2013-01797-004), and Blonigen (see record 2013-01797-005) on the original article by Marcus, Fulton, and Edens (see record 2011-23134-001). We wish to thank all of the authors for their thought-provoking and insightful comments about our meta-analysis. All of the comments addressed two of the major findings from our meta-analysis: (a) that the two factors of the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996; Lilienfeld & Widows, 2005), Fearless Dominance (FD) and Self-Centered Impulsivity (SCI), are orthogonal or weakly correlated; and (b) that FD was positively correlated with desirable traits indicative of psychological health (i.e., positive emotionality) and negatively associated with traits indicative of distress and psychopathology (i.e., negative emotionality; NEM). Where the commentators differed was in the meaning that they ascribed to this pattern of results.

Discrepancies between explicit and implicit self-esteem: implications for mate retention strategies and perceived infidelity.

The purpose of the present study was to examine whether the association between explicit self-esteem and relationship outcomes was moderated by implicit self-esteem. This was accomplished by asking 210 undergraduates who were currently involved in romantic relationships to complete measures of their explicit self-esteem, implicit self-esteem, mate retention strategies, and likelihood of future infidelity. Implicit self-esteem was found to moderate the association between high explicit self-esteem and relationship outcomes for male participants such that men with discrepant high self-esteem (i.e., high explicit self-esteem but low implicit self-esteem) reported less use of mate retention strategies and perceived a greater likelihood of future infidelity in their relationships during the next year. These findings provide additional support for the idea that fragile self-esteem may have consequences for the manner in which individuals perceive their relationships.

The relationship between anxiety sensitivity and disordered eating: the mediating role of experiential avoidance.

This study examined the role of experiential avoidance in the association between dimensions of anxiety sensitivity (AS) and disordered eating. A sample of 395 undergraduate students completed a series of questionnaires assessing the constructs of interest. Results indicate that the AS dimension of fear of cognitive dyscontrol was significantly uniquely associated with disordered eating. Furthermore, results provide support for a model in which experiential avoidance mediates the association between fear of cognitive dyscontrol and disordered eating. Findings of the present study highlight one potential mechanism underlying the association between AS and disordered eating, suggesting that efforts to avoid internal experiences may play a role in eating pathology. Clinical implications of these findings are discussed.

Examining the association between emotion regulation difficulties and probable posttraumatic stress disorder within a sample of African Americans.

This study examined the associations between emotion dysregulation and probable posttraumatic stress disorder (PTSD) among 180 African American undergraduates enrolled in a historically black college in the southern United States. Trauma-exposed participants with probable PTSD reported significantly higher levels of overall emotion dysregulation and the specific dimensions of lack of emotional acceptance, difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure and those with Criterion A traumatic exposure but no PTSD (controlling for age and negative affect). Furthermore, results indicated that participants with Criterion A traumatic exposure but no PTSD were significantly less likely to report difficulties controlling impulsive behaviors when distressed and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure (controlling for age and negative affect). These findings extend extant research on the role of emotion dysregulation in PTSD, thus providing support for the relevance of emotion dysregulation to PTSD among African American adults in particular.

Irrational health beliefs and health anxiety.

The Irrational Health Belief Scale (IHBS) assesses the tendency to appraise health-related information in an irrational manner. Despite the central role that dysfunctional assumptions about health play in the cognitive-behavioral model of hypochondriasis and health anxiety, researchers have not examined the relation between health anxiety and the types of irrational health beliefs assessed by the IHBS. Two samples (n = 198, n = 295) of students completed the IHBS and measures of anxiety and health anxiety. In both studies, the IHBS was correlated with health anxiety, and this association was mediated by anxiety. These findings suggest that the range of dysfunctional beliefs associated with health anxiety is greater than was initially described by the cognitive-behavioral model.

Is risky sexual behavior continuous or categorical? A taxometric analysis of the Sexual Risk Survey.

Risky sexual behaviors are behaviors that involve the possibility of an adverse outcome, such as contracting a sexually transmitted infection or unwanted pregnancy. The question of whether risky sexual behavior exists as a discrete class (i.e., taxon) or as a dimensional construct has not previously been explored. The authors performed a set of taxometric analyses on 4 factor scales derived from the Sexual Risk Survey (Turchik & Garske, 2009) with data from 1,103 college students. The results provided consistent support for a dimensional latent structure in which variations in reported risky sexual behavior reflect differences in degree and not differences in kind. The implications of these findings for the assessment of risky sexual behavior are discussed.

Lead and conduct problems: a meta-analysis.

This meta-analysis examined the association between conduct problems and lead exposure. Nineteen studies on 8,561 children and adolescents were included. The average r across all 19 studies was .19 (p < .001), which is considered a medium effect size. Studies that assessed lead exposure using hair element analysis yielded considerably larger effect sizes than those that assessed lead exposure using blood, tooth, or bone lead levels. Excluding the 3 hair analysis studies, the average r was .15 (p < .001). The age of the participants did not significantly moderate the relation between lead exposure and conduct problems. Overall, the relation between lead exposure and conduct problems was strikingly similar in magnitude to the relation between lead exposure and decreased IQ.