THE SELF-REFLECTION AND INSIGHT SCALE: A NEW MEASURE OF PRIVATE SELF-CONSCIOUSNESS

Adaptive functions of self-focused attention: Insight and depressive and anxiety symptoms

Maladaptive forms of self-focus, such as rumination, are considered transdiagnostic factors that contribute to depressive and anxiety symptoms. However, no or few studies have explored the possibility that adaptive forms of self-focus can also be a common factor that is negatively associated with depressive and anxiety symptoms. To test this possibility, we first examined the psychometric properties of a scale measuring adaptive forms of self-focus (the Self-Reflection and Insight Scale) on Japanese undergraduates (n=117). We replicated the two-factor structure of the scale: (a) self-reflection, which is a tendency to focus purposefully on self for self-regulation, and (b) insight, which is a sense of clear self-understanding. Second, we tested our specific hypothesis that these two factors negatively predict a common factor of depressive and anxiety symptoms. The results of structural equation modeling showed that insight (but not self-reflection) has a significant negative association with a latent variable that explains both depressive and anxiety symptoms. Furthermore, this common-factor model explained the data better than a control model in which insight predicts depressive and anxiety symptoms individually. These results suggest that (lack of) insight plays an important role in psychological (mal)adjustment as a shared process in depressive and anxiety symptoms.

The mediating effect of self-reflection and learning effectiveness on clinical nursing performance in nursing students: A follow-up study

The effectiveness of simulation learning and the effects of anxiety in the simulated situation have been understudied. In addition, research on the association between learning effectiveness and students' clinical care performance in the hospital setting is very limited in Taiwan. The aim of this study is to examine the mediating effect of self-reflection and simulation learning effectiveness on the clinical nursing performance of nursing students. A Prospective, longitudinal, and correlational design was used. The study was conducted from December 2014 to July 2015. Participants were 293 nursing students in southern Taiwan. A structural model was specified and tested using partial least squares structural equation modeling to examine the relationships between the variables. The results revealed that the model was robust in terms of its measurement quality (reliability, validity, and goodness of fit), with the data's explaining 38.3% of variance in nursing competence. As self-reflection and learning effectiveness were added into the structural model, the effect of anxiety on nursing competence was still significant, but the regression coefficient (β) estimate of -0.41 (p<0.05) changed to β=-0.15 (p<0.050),indicating that self-reflection and learning effectiveness mediated the relationship between anxiety and nursing competence. Nursing competence was negatively affected by anxiety and positively affected by self-reflection (β=0.49, p<0.05) and simulation learning effectiveness (β=0.10, p<0.05). The teacher's encouraging learning can have a positive influence on students' self-reflection and learning effectiveness, which then decreases the effect of anxiety on nursing competence and further promotes students' clinical care ability.

Assessing maladaptive repetitive thought in clinical disorders: A critical review of existing measures

Rumination and worry have recently been grouped under the broader transdiagnostic construct of repetitive thought (Watkins, 2008). The purpose of this review is to provide an overview of scales used to assess repetitive thinking across a broad range of contexts: depression, anxiety, trauma, stress, illness, interpersonal difficulties, positive affect, and so forth. We also include scales developed or adapted for children and adolescents. In the extant literature, measures of repetitive thinking generally show small-to-moderate correlations with measures of psychopathology. This review highlights problems with the content validity of existing instruments; for example, confounds between repetitive thought and symptomatology, metacognitive beliefs, and affect. This review also builds on previous reviews by including newer transdiagnostic measures of repetitive thinking. We hope that this review will help to expand our understanding of repetitive thinking beyond the mood and anxiety disorders, and suggest ways forward in the measurement of repetitive thinking in individuals with comorbid conditions.

Measuring the Effects of Self-Awareness: Construction of the Self-Awareness Outcomes Questionnaire

Dispositional self-awareness is conceptualized in several different ways, including insight, reflection, rumination and mindfulness, with the latter in particular attracting extensive attention in recent research. While self-awareness is generally associated with positive psychological well-being, these different conceptualizations are also each associated with a range of unique outcomes. This two part, mixed methods study aimed to advance understanding of dispositional self-awareness by developing a questionnaire to measure its outcomes. In Study 1, expert focus groups categorized and extended an initial pool of potential items from previous research. In Study 2, these items were reduced to a 38 item self-report questionnaire with four factors representing three beneficial outcomes (reflective self-development, acceptance and proactivity) and one negative outcome (costs). Regression of these outcomes against self-awareness measures revealed that self-reflection and insight predicted beneficial outcomes, rumination predicted reduced benefits and increased costs, and mindfulness predicted both increased proactivity and costs. These studies help to refine the self-awareness concept by identifying the unique outcomes associated with the concepts of self-reflection, insight, reflection, rumination and mindfulness. It can be used in future studies to evaluate and develop awareness-raising techniques to maximize self-awareness benefits while minimizing related costs.

Is self-reflection dangerous? Preventing rumination in career learning

Reflection is considered necessary and beneficial within career learning and is deemed to be a condition for successful career-identity development. Indeed, reflection is generally seen as a key competency in learning how to respond effectively to a complex and dynamic post-modern world in which individuals are increasingly exposed to risk. Paradoxically however, reflection can itself form a risk when it results in rumination. It is therefore important to identify the conditions and personal (risk) factors that make reflection a detrimental or beneficial activity and to identify elements within career-learning interventions that promote benefit. The purpose here is to increase awareness about reflective versus ruminative processes and promote responsible use of interventions that aim to stimulate reflection in the process of career-identity formation. Based on the “career writing” method, the authors conclude that a successful career intervention must especially provide good facilitation and a safe holding environment.

Self-Other Distinction Enhanced Empathic Responses in Individuals with Alexithymia

Although empathy is important for social interactions, individuals with alexithymia have low empathic ability, particularly where advanced empathy is concerned (empathic concern, perspective taking). It has been argued that awareness of the self-other distinction enhances advanced empathy, and alexithymics are thought to inadequately distinguish the self from others. We therefore tested whether the self-other distinction increases advanced empathy in alexithymics. To this end, we presented painful hand images over participants’ own hands, and required participants to estimate felt pain intensity and their affective states. Half of the participants got specific instructions to distinct themselves from the other in the images. Felt pain intensity (perspective taking) and other-oriented affective responses (empathic concern) were increased by the instructions only when participants had high alexithymia scores as measured by questionnaire, although self-oriented affective responses (personal distress) were not affected by the instructions. These findings indicate that enhancing the self-other distinction enhances alexithymics’ ability to use advanced empathy, but not the primitive empathy.

An integrated model for the effects of self-reflection and clinical experiential learning on clinical nursing performance in nursing students: A longitudinal study

BACKGROUND

The use of clinical simulation in undergraduate nursing programs in Taiwan has gradually increased over the past 5years. Previous research has shown that students' experience of anxiety during simulated laboratory sessions influences their self-reflection and learning effectiveness. Thus, further study that tracks what influences students' clinical performance in actual clinical sites is vital.

OBJECTIVE

The aim of the study is to develop an integrated model that considers the associations among anxiety, self-reflection, and learning effectiveness and to understand how this model applies to student nurses' clinical performance while on clinical placement.

DESIGN

This study used a correlational and longitudinal study design.

METHODS

The 80 nursing students, who ranged in age from 19 to 21 (mean=20.38, SD=0.56), were recruited from a nursing school in southern Taiwan. Data were collected during three phases of implementation using four questionnaires. During the first phase, the State-Trait Anxiety Inventory (STAI), Simulation Learning Effectiveness Scale (SLES), and Self-Reflection and Insight Scale (SRIS) were used after students completed the simulation course in the school simulation laboratory. Nursing students also completed the Holistic Nursing Competence Scale at 2months (Phase 2) and 4months (Phase 3) after clinical practice experience. In Phase 3, students again completed the STAI and SRIS. Partial least squares (PLS), a structural equation modeling (SEM) procedure, was used to test the research model.

RESULTS

The findings showed that: (1) at the start of the simulation laboratory, anxiety had a significant negative effect on students' simulation learning effectiveness (SLE; β=-0.14, p<0.05) and on self-reflection with insight (SRI; β=-0.52, p<0.01). Self-reflection also had a significant positive effect on simulation learning effectiveness (β=0.37, p<0.01). Anxiety had a significant negative effect on students' nursing competence during the first 2months of practice in a clinical nursing site (β=-0.20, p<0.01). Simulation learning effectiveness and self-reflection and insight also had a significant positive effect on nursing competence during the first 2months of practice in a clinical site (β=0.13; β=0.16, p<0.05), respectively; and (2) when students practice in a clinical setting, their previous experience of nursing competence during the first 2months of clinical care and their self-reflection and insight have a significant positive effect on their 4-month nursing competence (β=0.58; β=0.27, p<0.01). Anxiety, however, had a negative effect on 4-month nursing competence but not significantly. Overall, 41% of the variance in clinical nursing performance was accounted for by the variables in the integrated model.

CONCLUSION

This study highlights that self-reflection with insight and clinical experience may help students to deflect anxiety that may influence the development of clinical competence. Of note is that real-life clinical experience has a stronger effect on enhancing clinical performance than does a simulation experience.

Cortical salience network activation precedes the development of delusion severity

BACKGROUND

Delusion is the most characteristic symptom of psychosis. While researchers suggested an association between changes of the cortical salience network (CSN) and delusion, whether these CSN findings are a cause or a consequence of delusion remains unknown.

METHOD

To assess the effect of CSN functioning to forthcoming changes in delusion scores, we measured brain activation with 3-T functional magnetic resonance imaging in two independent samples of first-episode psychosis patients (total of 27 patients and 23 healthy controls). During scanning, the patients evaluated statements about whether an individual's psychosis-related experiences should be described as a mental illness, and control statements that were also evaluated by healthy controls. Symptoms were assessed at the baseline and at 2 months follow-up with Brief Psychiatric Rating Scale.

RESULTS

Both tasks activated the CSN in comparison with rest. Activation of CSN ('illness evaluation v. control task' contrast) in patients positively correlated with worsening of or less improvement in delusions at the 2-month follow-up assessment. This finding was independent of delusion and clinical insight scores at the baseline evaluation.

CONCLUSIONS

Our findings link symptom-evaluation-related CSN functioning to severity of delusion and, importantly, add a new layer of evidence for the contribution of CSN functioning to the longitudinal course of delusions.

Side Effects of Business Coaching and Their Predictors From the Coachees’ Perspective

Abstract. Sound research demonstrates the substantial positive effects of business coaching, but little is known about potential side effects. This study sheds light on the characteristics of side effects of coaching from the coachees’ perspective and investigates three possible predictors: relationship quality between coach and coachee, the coach’s expertise, and the coachees’ motivation to change. Data was collected in a time-lagged design from 111 coachees who received business coaching in Germany. Coachees reported that side effects were frequent but with low to moderate intensity. The number of side effects was negatively associated with relationship quality at both measurement times and with coach’s expertise at Time 1. Results expand knowledge about side effects of coaching and reveal opportunities for how they can be reduced.

The Busier the Better: Greater Busyness Is Associated with Better Cognition

Sustained engagement in mentally challenging activities has been shown to improve memory in older adults. We hypothesized that a busy schedule would be a proxy for an engaged lifestyle and would facilitate cognition. Here, we examined the relationship between busyness and cognition in adults aged 50-89. Participants (N = 330) from the Dallas Lifespan Brain Study (DLBS) completed a cognitive battery and the Martin and Park Environmental Demands Questionnaire (MPED), an assessment of busyness. Results revealed that greater busyness was associated with better processing speed, working memory, episodic memory, reasoning, and crystallized knowledge. Hierarchical regressions also showed that, after controlling for age and education, busyness accounted for significant additional variance in all cognitive constructs-especially episodic memory. Finally, an interaction between age and busyness was not present while predicting cognitive performance, suggesting that busyness was similarly beneficial in adults aged 50-89. Although correlational, these data demonstrate that living a busy lifestyle is associated with better cognition.

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

BACKGROUND

The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available.

OBJECTIVE

To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps.

METHODS

A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design.

RESULTS

Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp.

CONCLUSIONS

Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems.

Psychological Literacy Weakly Differentiates Students by Discipline and Year of Enrolment

Psychological literacy, a construct developed to reflect the types of skills graduates of a psychology degree should possess and be capable of demonstrating, has recently been scrutinized in terms of its measurement adequacy. The recent development of a multi-item measure encompassing the facets of psychological literacy has provided the potential for improved validity in measuring the construct. We investigated the known-groups validity of this multi-item measure of psychological literacy to examine whether psychological literacy could predict (a) students' course of enrolment and (b) students' year of enrolment. Five hundred and fifteen undergraduate psychology students, 87 psychology/human resource management students, and 83 speech pathology students provided data. In the first year cohort, the reflective processes (RPs) factor significantly predicted psychology and psychology/human resource management course enrolment, although no facets significantly differentiated between psychology and speech pathology enrolment. Within the second year cohort, generic graduate attributes (GGAs) and RPs differentiated psychology and speech pathology course enrolment. GGAs differentiated first-year and second-year psychology students, with second-year students more likely to have higher scores on this factor. Due to weak support for known-groups validity, further measurement refinements are recommended to improve the construct's utility.

Towards a framework in interaction training for staff working with clients with intellectual disabilities and challenging behaviour

BACKGROUND

Training support staff in dealing with challenging behaviour in clients with intellectual disabilities (ID) is needed. The goal of this study is to determine which elements need to be incorporated in a training on staff interactions with these clients, building upon a framework and an interpersonal model. As in functional analysis, this study tests the influence of client interpersonal behaviour, three types of staff reactions to challenging behaviour, two types of staff psychological resources and staff team climate on four styles of staff interpersonal behaviour.

METHOD

A total of 318 support staff members completed a questionnaire on staff interpersonal behaviour for 44 clients with ID and challenging behaviour, as well as seven questionnaires on client interpersonal behaviour, staff emotions, attributions, self-efficacy, self-reflection, coping styles and team climate. The influence of these seven factors on four staff interpersonal behaviours was examined using multilevel multiple regression analysis.

RESULTS

Friendly-warm and dominant client interpersonal behaviour had a significant positive impact on friendly and assertive control staff behaviour, respectively. Also, there was a strong influence of staff negative and positive emotions, as well as their self-efficacy, on most of the staff interpersonal behaviours. Staff self-reflection, insight and avoidance-focused coping style had an impact on some staff interpersonal behaviours. Staff team climate only predicted higher support-seeking staff behaviour.

CONCLUSIONS

In conducting a functional analysis of staff interpersonal behaviour, the results of this study can be used both as a framework in staff-client interaction training and in clinical practice for treating challenging behaviour. The emphasis in training and practice should not only be on the bidirectional dynamics of control and affiliation between staff and clients, but also - in order of importance - on the impact of staff emotions, self-efficacy, self-reflection and insight, coping style, team climate and attributions on staff interpersonal behaviour.

Critical features of peer assessment of clinical performance to enhance adherence to a low back pain guideline for physical therapists: a mixed methods design

BACKGROUND

Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously published randomized controlled trial showed that PA was more effective than the usual strategy "case discussion" in improving adherence to a low back pain guideline. Peer assessment aims to enhance knowledge, communication, and hands-on clinical skills consistent with guideline recommendations. Participants observed and evaluated clinical performance on the spot in a role-play simulating clinical practice. Participants performed three roles: physical therapist, assessor, and patient. This study explored the critical features of the PA program that contributed to improved guideline adherence in the perception of participants.

METHODS

Dutch physical therapists working in primary care (n = 49) organized in communities of practice (n = 6) participated in the PA program. By unpacking the program we identified three main tasks and eleven subtasks. After the program was finished, a questionnaire was administered in which participants were asked to rank the program tasks from high to low learning value and to describe their impact on performance improvement. Overall ranking results were calculated. Additional semi-structured interviews were conducted to elaborate on the questionnaires results and were transcribed verbatim. Questionnaires comments and interview transcripts were analyzed using template analysis.

RESULTS

Program tasks related to performance in the therapist role were perceived to have the highest impact on learning, although task perceptions varied from challenging to threatening. Perceptions were affected by the role-play format and the time schedule. Learning outcomes were awareness of performance, improved attitudes towards the guideline, and increased self-efficacy beliefs in managing patients with low back pain. Learning was facilitated by psychological safety and the quality of feedback.

CONCLUSION

The effectiveness of PA can be attributed to the structured and performance-based design of the program. Participants showed a strong cognitive and emotional commitment to performing the physical therapist role. That might have contributed to an increased awareness of strength and weakness in clinical performance and a motivation to change routine practice.

Online Self-Presentation on Facebook and Self Development During the College Transition

Self-presentation, a central element of young people's identity development, now extends from face-to-face contexts to social networking sites. Online self-presentation may change when youth transition to college, faced with the need to reclaim or redefine themselves in the new environment. Drawing on theories of self-presentation and self development, this study explores changes in youth's online self-presentation during their transition to a residential college. It also examines associations between online self-presentation and students' self-esteem and self-concept clarity. We surveyed 218 college freshmen (M age = 18.07; 64 % female, 79 % White) at the beginning and again at the end of their first semester. Freshmen's Facebook self-presentation became less restricted later in the semester. Broad, deep, positive, and authentic Facebook self-presentation was positively associated with perceived support from the audience, which contributed to higher self-esteem contemporaneously, though not longitudinally. Intentional Facebook self-presentation engaged students in self-reflection, which was related to lower self-concept clarity concurrently but higher self-esteem longitudinally. Findings clarified the paths from multifaceted online self-presentation to self development via interpersonal and intrapersonal processes during college transition.

Technologically Reflective Individuals as Enablers of Social Innovation

This paper identifies technologically reflective individuals and demonstrates their ability to develop innovations that benefit society. Technological reflectiveness (TR) is the tendency to think about the societal impact of an innovation, and those who display this capability in public are individuals who participate in online idea competitions focused on technical solutions for social problems (such as General Electric's eco-challenge, the James Dyson Award, and the BOSCH Technology Horizon Award). However, technologically reflective individuals also reflect in private settings (e.g., when reading news updates), thus requiring a scale to identify them. This paper describes the systematic development of an easy-to-administer multi-item scale to measure an individual's level of TR. Applying the TR scale in an empirical study on a health monitoring system confirmed that individuals' degree of TR relates positively to their ability to generate (1) more new product features and uses, (2) features with higher levels of societal impact, and (3) features that are more elaborated. This scale allows firms seeking to implement co-creation in their new product development (NPD) process and sustainable solutions to identify such individuals. Thus, this paper indicates that companies wishing to introduce new technological products with a positive societal impact may profit from involving technologically reflective individuals in the NPD process.

Decentering and Related Constructs: A Critical Review and Metacognitive Processes Model

The capacity to shift experiential perspective-from within one's subjective experience onto that experience-is fundamental to being human. Scholars have long theorized that this metacognitive capacity-which we refer to as decentering-may play an important role in mental health. To help illuminate this mental phenomenon and its links to mental health, we critically examine decentering-related constructs and their respective literatures (e.g., self-distanced perspective, cognitive distancing, cognitive defusion). First, we introduce a novel metacognitive processes model of decentering. Specifically, we propose that, to varying degrees, decentering-related constructs reflect a common mental phenomenon subserved by three interrelated metacognitive processes: meta-awareness, disidentification from internal experience, and reduced reactivity to thought content. Second, we examine extant research linking decentering-related constructs and their underlying metacognitive processes to mental health. We conclude by proposing future directions for research that transcends decentering-related constructs in an effort to advance the field's understanding of this facet of human experience and its role in (mal)adaptation.

Developmentally sensitive cognitive behavioral therapy for adolescent school refusal: rationale and case illustration

School refusal can be difficult to treat and the poorest treatment response is observed among older school refusers. This poor response may be explained, in part, by the impact of developmental transitions and tasks upon the young person, their family, and the treatment process. This paper describes and illustrates the @school program, a cognitive behavioral therapy (CBT) designed to promote developmental sensitivity when planning and delivering treatment for adolescent school refusal. Treatment is modularized and it incorporates progress reviews, fostering a planned yet flexible approach to CBT. The treatment is illustrated in the case of Allison, a 16-year-old female presenting with major depressive disorder and generalized anxiety disorder. A case formulation guided the selection, sequencing, and pacing of modules targeting predisposing, precipitating, perpetuating, and protective factors. Treatment comprised 16 sessions with Allison (interventions addressing depression, anxiety, and school attendance) and 15 concurrent sessions with her mother (strategies to facilitate an adolescent's school attendance), including two sessions with Allison and mother together (family communication and problem solving to reduce parent-adolescent conflict). Two treatment-related consultations were also conducted with Allison's homeroom teacher. Allison's school attendance improved during the course of treatment. By post-treatment, there was a decrease in internalizing behavior, an increase in self-efficacy, and remission of depressive disorder and anxiety disorder. Clinically significant treatment gains were maintained at 2-month follow-up. Factors influencing outcome may include those inherent to the @school program together with less specific factors. Special consideration is given to parents' use of both authoritative and autonomy-granting approaches when helping an adolescent to attend school.

Improving dynamic decision making through training and self-reflection

The modern business environment requires managers to make effective decisions in a dynamic and uncertain world. How can such dynamic decision making (DDM) improve? The current study investigated the effects of brief training aimed at improving DDM skills in a virtual DDM task. The training addressed the DDM process, stressed the importance of self-reflection in DDM, and provided 3 self-reflective questions to guide participants during the task. Additionally, we explored whether participants low or high in self-reflection would perform better in the task and whether participants low or high in self-reflection would benefit more from the training. The study also explored possible strategic differences between participants related to training and self-reflection. Participants were 68 graduate business students. They individually managed a computer-simulated chocolate production company called CHOCO FINE and answered surveys to assess self-reflection and demographics. Training in DDM led to better performance, including the ability to solve initial problems more successfully and to make appropriate adjustments to market changes. Participants’ self-reflection scores also predicted performance in this virtual business company. High self-reflection was also related to more consistency in planning and decision making. Participants low in self-reflection benefitted the most from training. Organizations could use DDM training to establish and promote a culture that values self-reflective decision making.

An innovative peer assessment approach to enhance guideline adherence in physical therapy: single-masked, cluster-randomized controlled trial

BACKGROUND

Clinical practice guidelines (CPGs) are not readily implemented in clinical practice. One of the impeding factors is that physical therapists do not hold realistic perceptions of their adherence to CPGs. Peer assessment (PA) is an implementation strategy that aims at improving guideline adherence by enhancing reflective practice, awareness of professional performance, and attainment of personal goals.

OBJECTIVE

The purpose of this study was to compare the effectiveness of PA with the usual case discussion (CD) strategy on adherence to CPGs for physical therapist management of upper extremity complaints.

DESIGN

A single-masked, cluster-randomized controlled trial with pretest-posttest design was conducted.

INTERVENTION

Twenty communities of practice (n=149 physical therapists) were randomly assigned to groups receiving PA or CD, with both interventions consisting of 4 sessions over 6 months. Both PA and CD groups worked on identical clinical cases relevant to the guidelines. Peer assessment focused on individual performance observed and evaluated by peers; CD focused on discussion.

OUTCOMES

Guideline adherence was measured with clinical vignettes, reflective practice was measured with the Self-Reflection and Insight Scale (SRIS), awareness of performance was measured via the correlation between perceived and assessed improvement, and attainment of personal goals was measured with written commitments to change.

RESULTS

The PA groups improved more on guideline adherence compared with the CD groups (effect=22.52; 95% confidence interval [95% CI]=2.38, 42.66; P=.03). The SRIS scores did not differ between PA and CD groups. Awareness of performance was greater for the PA groups (r=.36) than for the CD groups (r=.08) (effect=14.73; 95% CI=2.78, 26.68; P=.01). The PA strategy was more effective than the CD strategy in attaining personal goals (effect=0.50; 95% CI=0.04, 0.96; P=.03).

LIMITATIONS

Limited validity of clinical vignettes as a proxy measure of clinical practice was a limitation of the study.

CONCLUSIONS

Peer assessment was more effective than CD in improving adherence to CPGs. Personal feedback may have contributed to its effectiveness. Future research should address the role of the group coach.

Determinants of nursing competence of nursing students in Taiwan: the role of self-reflection and insight

BACKGROUND

A nursing practicum course is critical to strengthening the nursing competence of nursing students. Research has found that practice stress and coping behaviors can have either a negative or positive influence on the learning and practice performance of nursing students. Nevertheless, there are few evidence-based studies related to the relationship between self-reflection and insight and nursing competence in Taiwanese nursing students.

OBJECTIVE

To test the determinants and the effect of self-reflection and insight on nursing competence in nursing students during the first 2 months of their practice experience.

DESIGN

Cross-sectional and correlational research designs were employed.

METHODS

From September to November 2013, a total of 312 nursing students at a junior college in southern Taiwan served as participants in this study. Four questionnaires were used to collect data: Self-reflection and Insight Scale (SRIS), Perceived Stress Scale (PSS), Coping Behavior Inventory (CBI), and Holistic Nursing Competence Scale (HNCS). The research model was evaluated through structural equation modeling (SEM), with the use of the partial least squares (PLS) method.

RESULTS

Results indicated that self-reflection and insight, practice stress, and practice coping behavior were statistically significantly associated with nursing competence. In addition, self-reflection and insight were significantly and positively associated with practice coping behavior and negatively associated with practice stress. Students' coping behavior partially mediates the effect of self-reflection and stress on nursing competence. Overall, these variables explained 39.4% of the variance in these students' nursing competence.

CONCLUSION

Self-reflection and insight affected nursing competence during the practice period. These variables have not only had a direct influence on nursing competence but also an indirect effect through the mediating effect of coping behavior and stress.

The measurement of psychological literacy: a first approximation

Psychological literacy, the ability to apply psychological knowledge to personal, family, occupational, community and societal challenges, is promoted as the primary outcome of an undergraduate education in psychology. As the concept of psychological literacy becomes increasingly adopted as the core business of undergraduate psychology training courses world-wide, there is urgent need for the construct to be accurately measured so that student and institutional level progress can be assessed and monitored. Key to the measurement of psychological literacy is determining the underlying factor-structure of psychological literacy. In this paper we provide a first approximation of the measurement of psychological literacy by identifying and evaluating self-report measures for psychological literacy. Multi-item and single-item self-report measures of each of the proposed nine dimensions of psychological literacy were completed by two samples (N = 218 and N = 381) of undergraduate psychology students at an Australian university. Single and multi-item measures of each dimension were weakly to moderately correlated. Exploratory and confirmatory factor analyses of multi-item measures indicated a higher order three factor solution best represented the construct of psychological literacy. The three factors were reflective processes, generic graduate attributes, and psychology as a helping profession. For the measurement of psychological literacy to progress there is a need to further develop self-report measures and to identify/develop and evaluate objective measures of psychological literacy. Further approximations of the measurement of psychological literacy remain an imperative, given the construct's ties to measuring institutional efficacy in teaching psychology to an undergraduate audience.

It Takes Two to Be Yourself

Basic research suggests that authenticity is a potential important antecedent of responsible organizational behavior and occupational health. However, ambiguities concerning the concept’s content and boundaries and measurement problems limit cumulative theory building and easy adaption in organizational research. We address these barriers by integrating existing conceptualizations into a two-dimensional model of authenticity comprising a self-directed and an expression-oriented dimension and developing and validating an instrument for organizational research. We furthermore use the newly developed scale to address two controversies in authenticity research: Order of causality between authenticity and well-being and health and self-other agreement on authenticity and its correlates. Results from multiple samples provide evidence for content, discriminant, and criterion validity, as well as internal and temporal consistency of the integrated short scale. Self-reports and others’ ratings support both dimensions’ relevance for work-related variables and revealed insights into how others estimate authenticity. Longitudinal data provided evidence for antecedents and consequences and uncovered differences in the malleability of the dimensions.

The effects of gender and self-insight on early semantic processing

This event-related potential (ERP) study explored individual differences associated with gender and level of self-insight in early semantic processing. Forty-eight Chinese native speakers completed a semantic judgment task with three different categories of words: abstract neutral words (e.g., logic, effect), concrete neutral words (e.g., teapot, table), and emotion words (e.g., despair, guilt). They then assessed their levels of self-insight. Results showed that women engaged in greater processing than did men. Gender differences also manifested in the relationship between level of self-insight and word processing. For women, level of self-insight was associated with level of semantic activation for emotion words and abstract neutral words, but not for concrete neutral words. For men, level of self-insight was related to processing speed, particularly in response to abstract and concrete neutral words. These findings provide electrophysiological evidence for the effects of gender and self-insight on semantic processing and highlight the need to take into consideration subject variables in related research.

Functional connectivity mapping of regions associated with self- and other-processing

Neuroscience literature increasingly suggests a conceptual self composed of interacting neural regions, rather than independent local activations, yet such claims have yet to be investigated. We, thus, combined task-dependent meta-analytic connectivity modeling (MACM) with task-independent resting-state (RS) connectivity analysis to delineate the neural network of the self, across both states. Given psychological evidence implicating the self's interdependence on social information, we also delineated the neural network underlying conceptual other-processing. To elucidate the relation between the self-/other-networks and their function, we mined the MACM metadata to generate a cognitive-behavioral profile for an empirically identified region specific to conceptual self, the pregenual anterior cingulate (pACC), and conceptual other, posterior cingulate/precuneus (PCC/PC). Mining of 7,200 published, task-dependent, neuroimaging studies, using healthy human subjects, yielded 193 studies activating the self-related seed and were conjoined with RS connectivity analysis to delineate a differentiated self-network composed of the pACC (seed) and anterior insula, relative to other functional connectivity. Additionally, 106 studies activating the other-related seed were conjoined with RS connectivity analysis to delineate a differentiated other-network of PCC/PC (seed) and angular gyrus/temporoparietal junction, relative to self-functional connectivity. The self-network seed related to emotional conflict resolution and motivational processing, whereas the other-network seed related to socially oriented processing and contextual information integration. Notably, our findings revealed shared RS connectivity between ensuing self-/other-networks within the ventromedial prefrontal cortex and medial orbitofrontal cortex, suggesting self-updating via integration of self-relevant social information. We, therefore, present initial neurobiological evidence corroborating the increasing claims of an intricate self-network, the architecture of which may promote social value processing.

Effectiveness of peer assessment for implementing a Dutch physical therapy low back pain guideline: cluster randomized controlled trial

BACKGROUND

Clinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting.

OBJECTIVE

The aim of this study was to determine whether peer assessment is more effective than case-based discussions to improve knowledge and guideline-consistent clinical reasoning in the Dutch physical therapy guideline for low back pain (LBP).

DESIGN

A cluster randomized controlled trial was conducted.

SETTING AND PARTICIPANTS

Ten communities of practice (CoPs) of physical therapists were cluster randomized (N=90): 6 CoPs in the peer-assessment group (n=49) and 4 CoPs in the case-based discussion group (control group) (n=41).

INTERVENTION

Both groups participated in 4 educational sessions and used clinical patient cases. The peer-assessment group reflected on performed LBP management in different roles. The control group used structured discussions.

MEASUREMENTS

Outcomes were assessed at baseline and at 6 months. The primary outcome measure was knowledge and guideline-consistent reasoning, measured with 12 performance indicators using 4 vignettes with specific guideline-related patient profiles. For each participant, the total score was calculated by adding up the percentage scores (0-100) per vignette, divided by 4. The secondary outcome measure was reflective practice, as measured by the Self-Reflection and Insight Scale (20-100).

RESULTS

Vignettes were completed by 78 participants (87%). Multilevel analysis showed an increase in guideline-consistent clinical reasoning of 8.4% in the peer-assessment group, whereas the control group showed a decline of 0.1% (estimated group difference=8.7%, 95% confidence interval=3.9 to 13.4). No group differences were found on self-reflection.

LIMITATIONS

The small sample size, a short-term follow-up, and the use of vignettes as a proxy for behavior were limitations of the study.

CONCLUSIONS

Peer assessment leads to an increase in knowledge and guideline-consistent clinical reasoning.

Approach-Avoidance Attitudes Associated with Initial Therapy Appointment Attendance: A Prospective Study

Background: Initial therapy appointments have high nonattendance rates yet the reasons remain poorly understood. Aims: This study aimed to identify positive and negative attitudes towards therapy that predicted initial attendance, informed by a perceptual control theory account of approach-avoidance conflicts in help-seeking. Method: A prospective study was conducted within a low intensity CBT service using first appointment attendance (n = 96) as an outcome. Measures included attitudes towards therapy, depression and anxiety scales, and demographic variables. Results: Endorsement of a negative attitude item representing concern about self-disclosure was independently predictive of nonattendance. Positive attitudes predicted increased attendance, especially endorsement of motives for self-reflection, but only among less depressed individuals. Conclusions: Self-disclosure concerns contribute to therapy avoidance and having goals for self-reflection may represent approach motivation for therapy; however, the latter has less impact among more highly depressed people.

The need for absolute truth and self-rumination as basic suppressors in the relationship between private self-consciousness and mental health

Self-reflection has not so far been shown to have any specific benefits for mental health except for self-knowledge. Recent research showed that the controversy concerning the relationship between self-reflection and mental health could completely be eliminated if self-rumination and the need for absolute truth, especially the need for absolute truth, were considered as suppressor variables. This research replicated these findings in a different sample and expanded these findings by showing that the same is true for private self-consciousness. The need for absolute truth as a new variable was shown to be highly important in understanding the effects of self-consciousness on mental health.

Self-generated thoughts and depression: from daydreaming to depressive symptoms

Human minds often engage in thoughts and feelings that are self-generated rather than stimulus-dependent, such as daydreaming. Recent research suggests that under certain circumstances, daydreaming is associated with adverse effects on cognition and affect. Based on recent literature about the influence of resting mind in relation to rumination and depression, this questionnaire study investigated mechanisms linking daydreaming to depressive symptoms. Specifically, an indirect effect model was tested in which daydreaming influences depressive symptoms through enhancing self-focus and ruminative thought. Results were in line with the hypothesis and several alternative pathways were ruled out. The results provide initial supportive evidence that daydreaming can influence depressive symptoms through influences on self-focus and rumination. Further research should use prospective or experimental designs to further validate and strengthen these conclusions.

Self-absorption paradox is not a paradox: illuminating the dark side of self-reflection

Although considered an important component of a healthy personality, self-reflection has not so far been shown to have any specific benefits for mental health. This research addresses this issue by taking into consideration two important suppressor variables, self-rumination and the need for absolute truth. The latter is an innovative variable, defined and presented in this research. The first two studies aimed to validate a new measure that acts as an operational definition of the need for absolute truth. The first study was conducted with two group of participants; the first group consisted of 129 females and 67 males, mean age = 20 years, and the second 182 females and 104 males, mean age = 27. In the second study, participants were 22 females and 18 males, mean age = 20.5. In the final study, conducted with 296 female, 163 male participants (mean age = 37), suppressor effects were tested using structural equation modeling. The results showed that by taking account of these two suppressor variables, particularly the need for absolute truth, the expected relationship between self-reflection and mental health was revealed. The need for absolute truth was shown to be crucial for understanding the effects of self-reflection on mental health, therefore it should be considered in all processes of psychotherapy.

Trait self-focused attention increases sensitivity to nonconscious primes: evidence from effort-related cardiovascular reactivity

A broad range of primes presented outside of awareness - ranging from emotional faces to people's first names - can influence the physiological mobilization of effort during active coping tasks. Who responds more strongly to implicit cues? Based on models of self-awareness, the present research examined how individual differences in self-focused attention influence sensitivity to nonconscious primes. Adults completed a challenging cognitive task in which two kinds of primes were presented (people's first names and words related to the task's difficulty). Trait self-focus significantly interacted with both primes to predict effort, measured as systolic blood pressure (SBP) reactivity. People high in trait self-focus had significantly higher SBP reactivity when primed with words that made the task seem more important (their first names) and harder (high difficulty words). These findings thus expand the evidence for motivational intensity theory's analysis of implicit processes.

Alexithymia and its impact on quality of life in a group of Brazilian women with migraine without aura

Background

Migraine is a type of primary headache widely known for its impact on quality of life of patients. Although the psychological aspects of the disease are receiving increasing attention in current research, some of them, as alexithymia, are still seldom explored. This study aimed to provide evidence on the relationships between markers of depression, anxiety, alexithymia, self-reflection, insight and quality of life in migraine.

Methods

Forty female outpatients from a Brazilian specialized headache hospital service and a paired control group were compared.

Results

The results revealed that women with migraine had higher levels of depression, anxiety and alexithymia, and lower levels of quality of life, self-reflection and insight, compared to controls. Quality of life in women with migraine was predicted by levels of depression and one alexithymia factor (ability to express emotions and fantasies). A binary regression analysis between clinical and control groups revealed the migraine group to comprise individuals with high anxiety, low quality of life in the physical domain and the presence of a concrete thinking style.

Conclusions

The results highlight the relevance of considering psychological variables in the routine healthcare practices for migraine patients in general, while keeping steady attention to individual case features.

Pilot Study of an Investigation of Psychological Factors Associated with First Appointment Nonattendance in a Low-Intensity Service

Background: Nonattendance rates remain high for first therapy appointments, despite initiatives to increase access to psychological therapy. The reasons for nonattendance are poorly understood and studies of demographic and clinical predictors have produced conflicting findings. Aims: We aimed to pilot a method for investigating psychological factors associated with first appointment attendance in a primary care mental health service. Method: Questionnaires were completed by individuals at the point of referral to CBT with a low-intensity service in one general practice (n = 67), including a measure of beliefs, goals and attitudes towards therapy, as well as anxiety and depression scales. Subsequent attendance at the first appointment was used as an outcome. Results: Preliminary results showed that attendance was not associated with age or gender, severity of distress, or overall ratings for positive or negative attitudes towards therapy; although distress itself was associated with increased endorsement of negative attitudes. However, one specific psychological item, “Talking to a therapist will help me understand better how my mind works” had a significant association with subsequent attendance. Conclusions: The psychological factor that was associated with increased attendance may reflect the concept of psychological mindedness; however, this requires replication in a larger study. A full-scale study was deemed to be warranted based on this prospective design.