The moderating and mediating role of telepresence and cognitive change in cognitive behaviour therapy delivered via videoconference.

In this study, we combined the results of two controlled trials and examined the relationships between working alliance, telepresence, cognitive change and treatment outcome. Sixty-five participants with a primary diagnosis of generalized anxiety disorder (GAD) or panic disorder with agoraphobia (PDA) received cognitive behaviour therapy delivered via videoconference. Participants completed measures of working alliance and telepresence after three psychotherapy sessions. They also completed measures of treatment outcome and dysfunctional beliefs (cognitive change) specific to PDA and GAD at pretreatment and posttreatment. Results revealed that telepresence at the fifth session moderated the relationship between the working alliance at the first and fifth sessions. As telepresence increased, its impact on the working alliance diminished. Cognitive change mediated the relationship between the working alliance at the fifth session and treatment outcome.

The monster in the mirror: reasons for wanting to change appearance.

PURPOSE: Many adults are dissatisfied with their body, regardless of their weight, and weight loss is commonly perceived as an effective solution to this dissatisfaction. The main purpose of this study was to examine the reasons for wanting to modify one's bodily appearance (shape and weight), and to compare these reasons by sex, age, and weight group. METHODS: The sample consisted of 796 French-speaking Canadian adults (100 men, 696 women; M age = 27.00 years, SD = 7.88, range 18-64; M body mass index = 24.99 kg/m(2), SD = 6.37, range 12.6-66.5 kg/m(2)) who were asked online whether or not they wanted to change their appearance and if so, why. Answers were subjected to a content analysis wherein recurrent themes were grouped and labeled. RESULTS: Most participants (83.2%) wanted to change their appearance. Women, participants with a higher BMI, and older participants were significantly more likely to report this desire. The three most frequently evoked reasons were body dissatisfaction, well-being, and health/shape. CONCLUSIONS: The results suggest that body dissatisfaction constitutes the primary motive for change for both men and women of all ages, especially for those who are of healthy weight or underweight. Women and younger adults seem to be under the impression that in changing their appearance they will be more comfortable in their own skin. Men, older adults, and overweight adults, on the other hand, are more preoccupied by their health/shape and seldom relate their appearance to their psychological balance.

Gender differences in the interference of sleep difficulties and daytime sleepiness on school and social activities in adolescents.

OBJECTIVES: During adolescence, changes in the circadian and homeostatic systems, combined with psychosocial factors, create a phase delay in the sleep of adolescents. These changes in sleep are associated with increased sleep difficulties and a shortened sleep duration, which has a negative impact on daytime functioning of adolescents. Some studies showed that teenage girls report worse sleep quality and shorter sleep duration than boys during adolescence. The objective of this study was to investigate gender differences in the impact of sleep difficulties and sleepiness on daytime functioning in adolescents and to measure which aspect of sleep may interfere with daytime functioning in boys and girls. METHOD: A total of 731 adolescents (311 boys, 420 girls; age 13 to 17,5 years) completed questionnaires on sleep and daytime functioning. RESULTS: Compared to boys, teenage girls reported a significantly greater impact of short sleep duration and sleep difficulties on their school and social activities. Furthermore, our results suggest that the factors predicting the negative interference on daytime functioning seem to be more complex and multifactorial for girls than for boys. CONCLUSIONS: This study further emphasizes the importance of monitoring insufficient and poor sleep quality in adolescents, as these sleep variables seem to have a significant impact on their daytime functioning. Clinicians should also take into account gender when considering sleep issues in adolescents, as teenage girls and boys have different vulnerabilities and needs.

Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial.

BACKGROUND: In the context of the COVID-19 pandemic, legislations are being modified around the world to allow patients to receive mental health services through telehealth. Unfortunately, there are no large clinical trial available to reliably document the efficacy of delivering videoconferencing psychotherapy (VCP) for people with panic disorder and agoraphobia (PDA) and whether basic psychotherapeutic processes are altered. METHODS: This 2-arm intent-to-treat non-inferiority study reports on a clinical trial on VCP and documents how therapeutic working alliance and motivation toward psychotherapy are associated to treatment outcome. We hypothesized that VCP would not be inferior to standard face-to-face (FF) cognitive behavior therapy for PDA. No specific hypothesis was stated to address working alliance and treatment mechanisms. VCP was compared to a gold-standard psychotherapy treatment for PDA, which was delivered either in person or in videoconference, with a strict tolerance criterion of about 2 points on the primary outcome measure. Seventy one adult patients were recruited. Measures of working alliance were collected after the first, fifth, and last session. Motivation toward therapy at pre-treatment and working alliance after the fifth therapy session were used as predictors of treatment outcome and compared with change in dysfunctional beliefs toward bodily sensations. RESULTS: Panic disorder, agoraphobia, fear of sensations and depressed mood all showed significant improvements and large effect-sizes from pre to post-treatment. Gains were maintained at follow-up. No significant differences were found between VCP and FF, and effect sizes were trivial for three of the four outcome measures. Non-inferiority tests confirmed that VCP was no less effective than FF therapy on the primary outcome measure and two of the three secondary outcome measures. Working alliance was very strong in VCP and did not statistically differ from FF. Working alliance and motivation did not predict treatment outcome, which was significantly predicted by the reduction in dysfunctional beliefs. The strength of the therapeutic bond was correlated with change in dysfunctional beliefs. CONCLUSION: Mental health professionals can use VCP to provide services to patients with PDA. Building and maintaining a sound working alliance should not be a source concern. Practical recommendations are formulated. ISRCTN TRIAL REGISTRATION NUMBER: ISRCTN76456442.

Modeling the communication-satisfaction relationship in hospital patients.

OBJECTIVES: Although it has long been known that communication with medical professionals presents a strong relationship with patient satisfaction, research on this topic has been hindered by conceptual and methodological issues (e.g. single-item measures, inclusion of idiosyncratic patient characteristics, etc.). Using a more comprehensive and integrated approach, this study had two objectives: to document the multidimensional structure of the Picker Patient Experience-15, and to test a patient communication/satisfaction model that organizes its dimensions in a conceptually logical array of relationships. First, the factorial structure of the Picker Patient Experience-15 was hypothesized to comprise five dimensions: communication with patient, with family, addressing fears/concerns, preparation for discharge, and patient satisfaction. Second, the hypothesized model included positive relationships between all four communications dimensions, on the one hand, and patient satisfaction, on the other. Within communication dimensions, communication with patient was hypothesized to be the incipient factor for other dimensions, and thus to be positively associated with the other three forms of communication. METHODS: This research is based on a single time point design, which relied on administrative and questionnaire data. The study was conducted at a large University Hospital in Switzerland. The sample included 54,686 patients who received inpatient treatment, excluding those who were cared for in the intensive and intermediate care units. Patients filled out, over a 5-year period, the Picker Patient Experience questionnaire (PPE-15) after discharge (overall response rate of 41%). RESULTS: The proposed five-factor structure of the Picker Patient Experience-15 was successfully supported by the results of a confirmatory factor analysis. Moreover, the hypothesized network of associations between communication and satisfaction latent constructs was substantiated using structural equation modeling. With the exception of the association between preparation for discharge and patient satisfaction, the hypothesized model was fully corroborated. CONCLUSION: A more in-depth understanding of patient satisfaction can be achieved when it is studied as a multifaceted phenomenon.

On the self-regulation of implicit and explicit prejudice: a self -determination theory perspective.

The present study identifies a broad taxonomy of motives underlying the desire to regulate prejudice and assess the impact of motivation to regulate prejudice on levels of explicit and implicit prejudice. Using self-determination theory as the foundation, six forms of motivation to regulate prejudice are proposed. In Study 1 (N = 257), an exploratory factor analysis reveals evidence for the six proposed dimensions. In Study 2 (N = 198), the six-factor taxonomy of motivation to regulate prejudice is further validated using a confirmatory factor analysis, and construct validity is obtained. In Study 3 (N = 62), motivation to regulate prejudice is manipulated before participants complete the Implicit Association Test (IAT) and explicit measures of prejudice. Results reveal that those with highly self-determined regulation of prejudice demonstrate lower implicit and explicit prejudice than their less self-determined counterparts. Results are discussed in terms of an increased understanding of the motivation to control prejudice.