The prognostic value of electrodiagnostic testing in patients with sciatica receiving physical therapy.

PURPOSE: To investigate the prognostic value of electrodiagnostic testing in patients with sciatica receiving physical therapy. METHODS: Electrodiagnostic testing was performed on 38 patients with sciatica participating in a randomized trial comparing different physical therapy interventions. Patients were grouped and analyzed according to the presence or absence of radiculopathy based on electrodiagnostic testing. Longitudinal data analysis was conducted using multilevel growth modeling with ten waves of data collected from baseline through the treatment and post-treatment periods up to 6 months. The primary outcome measure was changes in low back pain-related disability assessed using the Roland and Morris disability questionnaire (RMDQ). RESULTS: Patients with radiculopathy (n = 19) had statistically significant and clinically meaningful improvements in RMDQ scores at every post-treatment follow-up occasion regardless of treatment received. The final multilevel growth model revealed improvements in RMDQ scores in patients with radiculopathy at the 6-week (-8.1, 95 % CI -12.6 to -2.6; P = 0.006) and 6-month (-4.1, 95 % CI -7.4 to -0.7; P = 0.020) follow-up occasions compared to patients without radiculopathy. Treatment group was not a significant predictive factor at any follow-up occasion. An interaction between electrodiagnostic status and time revealed faster weekly improvements in RMDQ scores in patients with radiculopathy at the 6-week (-0.72, 95 % CI -1.4 to -0.04; P = 0.040) through the 16-week (-0.30, 95 % CI, -0.57 to -0.04; P = 0.028) follow-up occasions compared to patients without radiculopathy. CONCLUSIONS: The presence of lumbosacral radiculopathy identified with electrodiagnostic testing is a favorable prognostic factor for recovery in low back pain-related disability regardless of physical therapy treatment received.

The association of therapist empathy and synchrony in vocally encoded arousal.

Empathy is a critical ingredient in motivational interviewing (MI) and in psychotherapy generally. It is typically defined as the ability to experience and understand the feelings of another. Basic science indicates that empathy is related to the development of synchrony in dyads. However, in clinical research, empathy has proved difficult to operationalize and measure, and has mostly relied on the felt sense of observers, clients, or therapists. We extracted estimates of therapist and standardized patient (SP) vocally encoded arousal (mean fundamental frequency; mean f0) in 89 MI sessions with high and low empathy ratings from independent observers. We hypothesized (a) therapist and SP mean f0 would be correlated and (b) the correlation of therapist and SP mean f0 would be greater in sessions with high empathy as compared with low. On the basis of a multivariate mixed model, the correlation between therapist and SP mean f0 was large (r = .71) and close to 0 in randomly assigned therapist-SP dyads (r = -.08). The association was higher in sessions with high empathy ratings (r = .80) than in sessions with low ratings (r = .36). There was strong evidence for vocal synchrony in clinical dyads as well as for the association of synchrony with empathy ratings, illustrating the relevance of basic psychological processes to clinical interactions. These findings provide initial evidence for an objective and nonobtrusive method for assessing therapist performance. Novel indicators of therapist empathy may have implications for the study of MI process as well as the training of therapists generally. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Interpersonal responses among sibling dyads tested for BRCA1/BRCA2 gene mutations.

OBJECTIVE: The familial context plays an important role in psychosocial responses to genetic testing. The purpose of this study was to compare sibling pairs with different combinations of BRCA1/BRCA2 test results on measures of affect, interpersonal responses, and physiological reactions. DESIGN: Forty-nine sibling dyads with different combinations of BRCA1/BRCA2 test results (i.e., mixed, positive, negative) completed a questionnaire, and 35 of the dyads also participated in a laboratory-based discussion of genetic testing. MAIN OUTCOME MEASURES: The primary outcome variables included participant reports of supportive actions toward their sibling, state anger and anxiety, perceptions of sibling behavior, and electrodermal responses. RESULTS: Compared to positive and negative dyads, mixed pairs reported less friendly general support actions, noted more anger, and perceived their sibling to be less friendly and more dominant during the interactions. In comparisons between same-result (i.e., positive, negative) pairs, positive dyads reported more dominant support behaviors and perceived their sibling to be friendlier during the interactions. CONCLUSION: Data suggest that siblings who have different test results may experience more interpersonal strain than siblings who have the same test result. Future research on genetic testing and family relationships can expand upon these findings.

Benchmarking the effectiveness of psychotherapy treatment for adult depression in a managed care environment: a preliminary study.

This preliminary study evaluated the effectiveness of psychotherapy treatment for adult clinical depression provided in a natural setting by benchmarking the clinical outcomes in a managed care environment against effect size estimates observed in published clinical trials. Overall results suggest that effect size estimates of effectiveness in a managed care context were comparable to effect size estimates of efficacy observed in clinical trials. Relative to the 1-tailed 95th-percentile critical effect size estimates, effectiveness of treatment provided in this setting was observed to be between 80% (patients with comorbidity and without antidepressants) and 112% (patients without comorbidity concurrently on antidepressants) as compared to the benchmarks. Because the nature of the treatments delivered in the managed care environment were unknown, it was not possible to make conclusions about treatments. However, while replications are warranted, concerns that psychotherapy delivered in a naturalistic setting is inferior to treatments delivered in clinical trials appear unjustified.

New measures improve the accuracy of the directed-lie test when detecting deception using a mock crime.

The present study tested the accuracy of probable-lie and directed-lie polygraph tests. One hundred and twenty men and women were recruited from the general community and paid $30 to participate in a mock crime experiment. Equal numbers of males and females were assigned to either the guilty or innocent condition with equal numbers in each group receiving either a probable-lie or a directed-lie polygraph test resulting in a 2 x 2 design with two experimental factors (test type and deceptive condition). Half of the participants were guilty and half were innocent of committing a mock theft of $20 from a purse. All participants were paid a $50 bonus if they could convince the polygraph examiner that they were innocent. There were no significant differences in decision accuracy between probable-lie and directed-lie tests, but respiration measures were more diagnostic for the probable-lie test. New physiological measures, skin potential excursion and a new respiratory measure improved the accuracy of the directed-lie test such that 86% of the innocent participants and 93% of the guilty participants were correctly classified.

The influence of attitudes, acculturation, and gender on substance use for Mexican American middle school students.

The present study tested if current drug use was related to acculturation (measured by language spoken at home), gender, or youth attitudes towards drugs in a large sample of 8th grade, predominantly Mexican American, Hispanic youth. The data were obtained via self-report survey from 2964 Hispanic youth in 108 schools. Hierarchical linear modeling (HLM) was used to test if acculturation, gender, or youth attitudes towards drugs predicted past 30-day use of alcohol, inhalant, or marijuana use and assess school-level influences. Acculturation and gender interacted with attitudes towards drugs to predict current alcohol use. Gender interacted with attitudes towards drugs to predict current alcohol and inhalant use. Having positive attitudes towards drugs was related to increased substance use for all three drug types. Hispanic eighth grade girls had significantly higher use rates than boys for both alcohol and inhalants. Additional research is needed to better understand the influence of acculturation on substance use among Hispanic youth.

Benchmarks for psychotherapy efficacy in adult major depression.

This study estimates pretreatment-posttreatment effect size benchmarks for the treatment of major depression in adults that may be useful in evaluating psychotherapy effectiveness in clinical practice. Treatment efficacy benchmarks for major depression were derived for 3 different types of outcome measures: the Hamilton Rating Scale for Depression (M. A. Hamilton, 1960, 1967), the Beck Depression Inventory (A. T. Beck, 1978; A. T. Beck & R. A. Steer, 1987), and an aggregation of low reactivity-low specificity measures. These benchmarks were further refined for 3 conditions: treatment completers, intent-to-treat samples, and natural history (wait-list) conditions. The study confirmed significant effects of outcome measure reactivity and specificity on the pretreatment-posttreatment effect sizes. The authors provide practical guidance in using these benchmarks to assess treatment effectiveness in clinical settings.

Validation of semantic illusions independent of anomaly detection: evidence from eye movements.

Several theorists have argued that readers fail to detect semantic anomalies during reading, and that these effects are indicative of "shallow processing" behaviours. Previous studies of semantic anomalies such as the Moses illusion have focused primarily on explicit detection tasks. In the present study, we examined participants' eye movements as they read true/false statements that were non-anomalous, or contained a semantic anomaly that was either high- or low-related to the correct information. Analyses of reading behaviours revealed that only low-related detected anomalies resulted in initial processing difficulty, but both detected and undetected anomalies, regardless of whether they were high- or low-related, resulted in delayed processing difficulty. The results extend previous findings on semantic anomalies and are discussed in terms of the RI-Val model of text processing.

Psychophysiological detection of deception and Preliminary Process Theory: a comment on Palmatier and Rovner (2015).

Palmatier and Rovner (2015) argued that the same psychophysiological processes underlie the outcomes of the Comparison Question Test (CQT) and the Concealed Information Test (CIT). They also argued that Barry's Preliminary Process Theory (PPT) explains the patterns of physiological reactions that occur during polygraph examinations. There is ample empirical evidence that the CQT and CIT produce similar physiological effects. Although PPT may account for those effects, the authors' argument was not persuasive. Demonstrations of effects on targeted response systems that are predicted by PPT but are not predicted by Sokolov's orienting theory would bolster their case and encourage much needed conceptual development and construct validation of polygraph techniques.

Analog assessment of frustration tolerance: association with self-reported child abuse risk and physiological reactivity.

Although frustration has long been implicated in promoting aggression, the potential for poor frustration tolerance to function as a risk factor for physical child abuse risk has received minimal attention. Instead, much of the extant literature has examined the role of anger in physical abuse risk, relying on self-reports of the experience or expression of anger, despite the fact that this methodology is often acknowledged as vulnerable to bias. Therefore, the present investigation examined whether a more implicit, analog assessment of frustration tolerance specifically relevant to parenting would reveal an association with various markers of elevated physical child abuse risk in a series of samples that varied with regard to age, parenting status, and abuse risk. An analog task was designed to evoke parenting-relevant frustration: the task involved completing an unsolvable task while listening to a crying baby or a toddler's temper tantrum; time scores were generated to gauge participants' persistence in the task when encountering such frustration. Across these studies, low frustration tolerance was associated with increased physical child abuse potential, greater use of parent-child aggression in discipline encounters, dysfunctional disciplinary style, support for physical discipline use and physical discipline escalation, and increased heart rate. Future research directions that could better inform intervention and prevention programs are discussed, including working to clarify the processes underlying frustration intolerance and potential interactive influences that may exacerbate physical child abuse.

Reproducibility of ABC/2 method to determine infarct volume and mismatch percentage with CT perfusion.

BACKGROUND: Our aim is to implement a simple, rapid, and reliable method using computed tomography perfusion imaging and clinical judgment to target patients for reperfusion therapy in the hyper-acute stroke setting. We introduce a novel formula (1-infarct volume [CBV]/penumbra volume [MTT] × 100%) to quantify mismatch percentage. METHODS: Twenty patients with anterior circulation strokes who underwent CT perfusion and received intravenous tissue plasminogen activator (IV tPA) were analyzed retrospectively. Nine blinded viewers determined volume of infarct and ischemic penumbra using the ABC/2 method and also the mismatch percentage. RESULTS: Interrater reliability using the volumetric formula (ABC/2) was very good (intraclass correlation [ICC] = .9440 and ICC = .8510) for hemodynamic parameters infarct (CBV) and penumbra (MTT). ICC coefficient using the mismatch formula (1-MTT/CBV × 100%) was good (ICC of .635). CONCLUSIONS: The ABC/2 method of volume estimation on CT perfusion is a reliable and efficient approach to determine infarct and penumbra volumes. The 1-CBV/MTT × 100% formula produces a mismatch percentage assisting providers in communicating the proportion of salvageable brain and guides therapy in the setting of patients with unclear time of onset with potentially salvageable tissue who can undergo mechanical retrieval or intraarterial thrombolytics.

Relationship between perceived and actual frequency represented by common rating scale labels.

Two experiments investigated the relationship between subjective interpretation of frequency terms and corresponding objective values. Evidence supported the existence of a nonlinear relationship that is well described by a logarithmic function. The general form of this relationship was consistent across different methods of eliciting subjective frequency estimates and different frequency response scales. These findings, in combination with prior research, suggest that individuals can be highly accurate in reporting the frequency of prior experiences but that subjective reports using common frequency response scales and scoring methods should not be taken to reflect equal intervals of actual frequency. This bears similarity to psychophysical relationships observed between sensation and stimulus intensity, and it has implications for the interpretation and analysis of self-report measures that use Likert-type frequency response scales.

Lyin' eyes: ocular-motor measures of reading reveal deception.

Our goal was to evaluate an alternative to current methods for detecting deception in security screening contexts. We evaluated a new cognitive-based test of deception that measured participants' ocular-motor responses (pupil responses and reading behaviors) while they read and responded to statements on a computerized questionnaire. In Experiment 1, participants from a university community were randomly assigned to either a "guilty" group that committed one of two mock crimes or an "innocent" group that only learned about the crime. Participants then reported for testing, where they completed the computer-administered questionnaire that addressed their possible involvement in the crimes. Experiment 2 also manipulated participants' incentive to pass the test and difficulty of statements on the test. In both experiments, guilty participants had increased pupil responses to statements answered deceptively; however, they spent less time fixating on, reading, and rereading those statements than statements answered truthfully. These ocular-motor measures were optimally weighted in a discrimination function that correctly classified 85% of participants as either guilty or innocent. Findings from Experiment 2 indicated that group discrimination was improved with greater incentives to pass the test and the use of statements with simple syntax. The present findings suggest that two cognitive processes are involved in deception-vigilance and strategy-and that these processes are reflected in different ocular-motor measures. The ocular-motor test reported here represents a new approach to detecting deception that may fill an important need in security screening contexts.

Multilevel models for repeated measures research designs in psychophysiology: an introduction to growth curve modeling.

Psychophysiologists often use repeated measures analysis of variance (RMANOVA) and multivariate analysis of variance (MANOVA) to analyze data collected in repeated measures research designs. ANOVA and MANOVA are nomothetic approaches that focus on group means. Newer multilevel modeling techniques are more informative than ANOVA because they characterize both group-level (nomothetic) and individual-level (idiographic) effects, yielding a more complete understanding of the phenomena under study. This article was written as an introduction to growth curve modeling for applied researchers. A growth model is defined that can be used in place of RMANOVAs and MANOVAs for single-group and mixed repeated measures designs. The model is expanded to test and control for the effects of baseline levels of physiological activity on stimulus-specific responses. Practical, conceptual, and statistical advantages of growth curve modeling are discussed.

Religious orientation, aging, and blood pressure reactivity to interpersonal and cognitive stressors.

BACKGROUND: Research on religion and health suggests general health benefits for those who are more religiously involved. Particular aspects of religiosity that may influence this finding, however, have not been sufficiently investigated. PURPOSE: This study was designed to explore the relationship between religious orientation (intrinsic, extrinsic) and blood pressure reactivity among older (over 60 years) and younger (18-24 years) adults exposed to two qualitatively different laboratory stressors (cognitive, interpersonal). METHODS: Participants were categorized as exhibiting either a predominantly intrinsic or extrinsic religious orientation based on scores on the Religious Orientation Scale. They were subsequently exposed (in counterbalanced order) to two laboratory stressors that varied in terms of whether an interpersonal confrontation was involved. Measures of blood pressure were obtained at baseline and during stressor presentation. RESULTS: Analyses indicated that older extrinsically religious individuals demonstrated exaggerated reactivity compared to younger participants and older intrinsically religious individuals. Older intrinsically religious participants did not differ from younger persons. Similar results were found for analysis of baseline data. Extrinsic participants had greater reactivity during the interpersonal confrontation condition than did intrinsic individuals. CONCLUSIONS: These findings suggest that religious orientation may be an important variable to study regarding cardiovascular reactivity in, particularly, older adults.