Through Benevolent Eyes: the Differential Efficacy of Perspective Taking and Cognitive Reappraisal on the Regulation of Shame.

Difficulties in regulating feelings of shame is a risk factor for the onset and recurrence of mental health disorders. The present research investigated the impact of the individual differences in propensity to experience shame (or shame-proneness) on two emotion regulation strategies-perspective taking and positive reappraisal. A total of 228 participants, undergraduate students, were allocated randomly to one of the eight experimental conditions. The results revealed that for high shame-prone participants, the use of perspective taking, without positive reappraisal, led to a heightened experience of shame. In contrast, the combination of perspective taking and positive reappraisal led to reductions in shame among high shame-prone participants. The findings highlight the relationship between individual differences, and the separate and combined effects of affect regulation strategies on the experience of shame.

A randomized waitlist control community study of Social Cognition and Interaction Training for people with schizophrenia.

OBJECTIVE: Social Cognition and Interaction Training (SCIT) has demonstrated effectiveness in improving social cognition and functioning of people with schizophrenia. This pilot study examines the acceptability, feasibility, and effectiveness of SCIT with individuals who have schizophrenia-spectrum disorders and are receiving care through a public mental health service. METHOD: In a pragmatic randomized waitlist controlled trial, 36 participants (aged 19-55 years) with a schizophrenia spectrum disorder were randomly allocated to SCIT or treatment as usual (TAU). Measures of theory of mind, emotion perception, attributional bias, social skills, quality of life, life skills, depression, anxiety, and stress were administered pre- and post-intervention with follow-up conducted 4 months later. All wait-list controls subsequently received the intervention and a secondary within-group analysis was conducted including these participants. RESULTS: While no significant differences were found between groups on any outcomes, there was strong engagement with the SCIT intervention. Of the 21 participants in the intervention group, the completion rate was 85.71% with a median attendance rate of 17 sessions. Within subject analyses of SCIT participants over time showed significant improvements in quality of life, emotion recognition, social skills, and a trend towards better life skills from pre- to post-intervention. These gains were sustained at the 4-month follow-up time. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although this study showed limited benefits in outcomes associated with SCIT compared with TAU, it demonstrated the acceptability of SCIT to participants in a real world public health setting shown by high retention, attendance, and positive feedback. This pilot shows SCIT can be implemented in routine clinical practice and lays the foundation for a larger pragmatic study. PRACTITIONER POINTS: SCIT can be implemented successfully in a real-world community mental health setting. SCIT had high levels of acceptability to these participants. Limitations The small sample size meant there was insufficient power to detect differences between groups on outcome measures. The study did not include measures of psychiatric symptoms or neuropsychological functioning which may have influenced participants' capacity to benefit from SCIT.

The association between state attachment security and state Mindfulness.

Recent research suggests that attachment and mindfulness are related, though the nature of this association is unclear. Here we present two studies examining whether there is a causal relationship between state attachment and state mindfulness. Study 1 investigated the effects of experimentally increasing state mindfulness on state attachment security. State mindfulness was successfully enhanced, but this led to no change in state attachment security. Study 2 investigated the effects of experimentally enhancing state attachment security on state mindfulness. State attachment security was successfully enhanced, but this did not lead to any change in state mindfulness. These findings suggest that there is not a direct, immediate causal relationship between state attachment and state mindfulness as a result of brief experimental manipulations. Future research should examine these associations in longer term interventions.

The daily living self-efficacy scale: a new measure for assessing self-efficacy in stroke survivors.

PURPOSE: To develop and examine the psychometric properties of the Daily Living Self-Efficacy Scale (DLSES) designed to assess stroke survivors' self-efficacy in daily functioning. METHOD: Two groups of participants (N = 424) were recruited, a stroke survivor group (n = 259) who were recruited through two stroke associations in Australia and a non-stroke group (n = 165) who were the partners/carers of the stroke survivors (n = 93) and members of the community in Queensland, Australia (n = 72). Principal Component Analyses (PCA) were used to assess the factor structure of the scale and investigations of internal consistency, test-retest reliability, convergent and discriminant validity were conducted. RESULTS: The final measure is a 12-item scale comprising two subscales: self-efficacy for psychosocial functioning and self-efficacy for activities of daily living. The scale demonstrated high internal consistency, temporal stability and convergent validity, and it discriminated well between the stroke and non-stroke groups. CONCLUSION: The DLSES is a psychometrically sound measure of self-efficacy in psychosocial functioning and self-efficacy in activities of daily living appropriate for stroke survivors, regardless of level of physical impairment. Implications for Rehabilitation A key factor that may influence outcome following a stroke is the level of self-efficacy that stroke survivors have in their ability to function in their daily life. The DLSES provides a measure of this ability that may be useful in enhancing preparation for the return to the community. The DLSES assesses self-efficacy in two important areas of daily functioning--activities of daily living and psychosocial functioning. This new measure can be administered to stroke individuals regardless of the nature or degree of physical impairment.

Craving as a predictor of treatment outcomes in heavy drinkers with comorbid depressed mood.

Alcohol and depression comorbidity is high and is associated with poorer outcomes following treatment. The ability to predict likely treatment response would be advantageous for treatment planning. Craving has been widely studied as a potential predictor, but has performed inconsistently. The effect of comorbid depression on craving's predictive performance however, has been largely neglected, despite demonstrated associations between negative affect and craving. The current study examined the performance of craving, measured pre-treatment using the Obsessive subscale of the Obsessive Compulsive Drinking Scale, in predicting 18-week and 12-month post-treatment alcohol use outcomes in a sample of depressed drinkers. Data for the current study were collected during a randomized controlled trial (Baker, Kavanagh, Kay-Lambkin, Hunt, Lewin, Carr, & Connolly, 2010) comparing treatments for comorbid alcohol and depression. A subset of 260 participants from that trial with a Timeline Followback measure of alcohol consumption was analyzed. Pre-treatment craving was a significant predictor of average weekly alcohol consumption at 18 weeks and of frequency of alcohol binges at 18 weeks and 12 months, but pre-treatment depressive mood was not predictive, and effects of Baseline craving were independent of depressive mood. Results suggest a greater ongoing risk from craving than from depressive mood at Baseline.

Mechanisms underlying aggressive and hostile behavior in amphetamine users.

PURPOSE OF REVIEW: To review current evidence linking amphetamine use with aggression and to consider possible factors that might underlie this association. RECENT FINDINGS: Although evidence that amphetamine use is related to increased levels of aggression continues to grow, the underlying processes or mechanisms remain somewhat elusive. In this review, three possible underlying factors are considered. Neurotoxic, pharmacological effects of amphetamine on the dopaminergic and serotonergic systems are related to aggressive, hostile behavior in both animal and human studies. Of particular interest is the converging evidence that amphetamine use is related to impairment in executive functions (including self-control) that are regulated by the prefrontal cortex. Taken together, these findings suggest that amphetamine users may have an impaired capacity to control or inhibit aggressive impulses. Furthermore, high levels of impulsivity related to amphetamine use may also play a role. Finally, amphetamine use is associated with increased positive symptoms of psychosis, particularly paranoia, that contribute to a perception of the environment as a hostile, threatening place. SUMMARY: Taken separately, each of these factors may lead to an increase in aggression with increased use of amphetamine, but their interactive or synergistic effects may be particularly problematic.

Impulsivity and positive psychotic symptoms influence hostility in methamphetamine users.

Methamphetamine (MA) use is associated with hostility, aggression, and positive psychotic symptoms. However, little is known of the processes or mechanisms that underlie this relationship. The present research was designed to investigate putative mediating and moderating variables between MA dependence and hostility in a sample of injecting MA users (N=237). Both positive symptoms of psychosis and higher levels of impulsivity functioned as mediators and moderators of this relationship. This pattern of findings suggests that MA use leads to greater hostility by increasing positive psychotic symptoms that contribute to a perception of the environment as a hostile and threatening place as well as by increasing impulsivity. Those who were high in positive symptoms and high in impulsivity were the most hostile. Individual differences in impulsivity and positive psychotic symptoms should be taken into account in the assessment and management of MA dependence.

Needs assessment and current practice of alcohol risk assessment of pregnant women and women of childbearing age by primary health care professionals.

BACKGROUND: Assessing the current practices and learning and resource needs of primary health care professionals in regards to their alcohol risk assessment practices is an important step in providing optimal training and educational methods. Needs and current practices in alcohol risk assessment of pregnant women and women of child bearing years may vary according to practitioner demographics. METHODS: To appraise alcohol risk assessment current practices and learning and resource needs among Saskatchewan primary health care professionals, a mail and online survey was distributed in the spring of 2006 to family physicians/general practitioners and nurse practitioners. RESULTS: In total, 876 surveys were distributed and 386 were returned for an overall response rate of 44.1%. The majority of survey respondents reported either rarely or never using a standardized screening tool in assessing alcohol risk in women or reported using a standardized screening tool that is less sensitive. Current practices varied according to gender, length of time in practice and practice location, while learning and resource needs were more likely to be identified by nurse practitioners, female physicians, and physicians from rural areas. Physicians who had practiced for less than 5 years were more likely to want an online course. DISCUSSION: Knowing the needs and practices of health care professionals may assist learning and resource training and could assist in teaching best practices in alcohol risk assessment. Assessing alcohol risk in pregnant women and women of childbearing age is critical for prevention of FASD.

Patterns of postoperative systemic vascular resistance in a randomized trial of conventional on-pump versus off-pump coronary artery bypass graft surgery.

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) is associated with a less intense systemic inflammatory response according to biochemical markers. We studied systemic vascular resistance (SVR) as a physiologic response to systemic inflammatory response to determine any differences between OPCAB and on-pump coronary artery bypass grafting (ONCAB) in a prospective randomized trial. METHODS: One hundred consecutive patients were randomized to OPCAB or ONCAB, 50 in each group. Antifibrinolytics and steroids were not used. All protocols were identical except for cardiopulmonary bypass. Temperature, SVR index, cardiac index, and blood pressure were measured continuously for the first 24 hours postoperatively. All patients were reviewed at 30 days. RESULTS: There was no 30-day mortality, no stroke, and no acute renal failure. Mean temperature peaked at 37.5 degrees C at 12 hours (p = 0.700 between groups). Mean SVR index fell to 1,900 dyne x cm(-5) x m(-2) at 12 to 18 hours; 42% of OPCAB and 32% of ONCAB patients developed very low SVR index (<1,500 dyne x cm(-5) x m(-2)). The incidence of high SVR (>2,500 dyne x cm(-5) x m(-2)) fell from 20% to 2% by 12 to 18 hours. The extent and pattern of SVR index responses were similar in both groups (p = 0.840). Mean cardiac index peaked at 3.0 L x min(-1) x m(-2), 12 to 18 hours postoperatively (p = 0.815 between groups); 84% of OPCAB and 90% of ONCAB had cardiac index greater than 2.2 L x min(-1) x m(-2) at all times. Only 10% of patients required vasopressors. Blood pressure responses were also similar (p = 0.314). CONCLUSIONS: The incidence of low SVR, and patterns of SVR changes were similar in ONCAB and OPCAB, and were clinically unimportant as few patients required vasopressor support. Cardiac outputs and clinical outcomes were excellent in both groups.

The influence of attachment and emotional support in end-stage cancer.

The impact of attachment style and emotional support on negative affect in 67 end-stage cancer patients was examined via self-report inventory. Path analysis revealed high levels of both attachment anxiety and attachment avoidance were associated with lower levels of emotional support which, in turn, had a major adverse influence on patients' negative affect. In addition, attachment anxiety was also directly associated with distress. The discussion emphasises the importance of attachment theory and emotional support within the context of terminal cancer.