Moderators of short- and long-term outcomes in panic control treatment and panic-focused psychodynamic psychotherapy

OBJECTIVE

The objective was to test the hypothesis that externalizing and internalizing helpfulness beliefs and learning styles at baseline moderate panic severity and overall mental illness as short-term and long-term outcomes of two panic-focused psychotherapies, Panic Control Treatment (PCT) and Panic-Focused Psychodynamic Psychotherapy (PFPP).

METHOD

Participants were 108 adults with DSM-IV Panic Disorder with or without Agoraphobia (PD/A) who were randomized to treatment in a trial of PCT and PFPP. Piece-wise/segmented multilevel modeling was used to test three-way interactions (Treatments × Moderator × Time), with participants and therapists as random factors. Outcome variables were clinician-rated panic severity and self-rated mental illness post-treatment and during follow-up.

RESULTS

Patients' externalizing (but not internalizing) helpfulness beliefs moderated mental illness outcomes during follow-up (but not during treatment); low levels of Externalization were facilitative for PFPP but not PCT. Internalizing and externalizing helpfulness beliefs and learning style did not moderate clinician-rated panic severity, whether short- or long-term.

CONCLUSIONS

These results suggest that helpfulness beliefs and learning style have limited use in assignment to either PCT or PFPP for PD/A. Although further research is needed, low levels of helpfulness beliefs about externalizing coping may play a role in mental illness outcomes for PFPP.

Power Analysis for Moderator Effects in Longitudinal Cluster Randomized Designs

Cluster randomized control trials often incorporate a longitudinal component where, for example, students are followed over time and student outcomes are measured repeatedly. Besides examining how intervention effects induce changes in outcomes, researchers are sometimes also interested in exploring whether intervention effects on outcomes are modified by moderator variables at the individual (e.g., gender, race/ethnicity) and/or the cluster level (e.g., school urbanicity) over time. This study provides methods for statistical power analysis of moderator effects in two- and three-level longitudinal cluster randomized designs. Power computations take into account clustering effects, the number of measurement occasions, the impact of sample sizes at different levels, covariates effects, and the variance of the moderator variable. Illustrative examples are offered to demonstrate the applicability of the methods.

Effects of the Collaborative Assessment and Management of Suicidality (CAMS) Model: A Secondary Analysis of Moderation and Influencing Factors

In a randomized controlled trial, we found that suicidal patients who received Collaborative Assessment and Management of Suicidality (CAMS) reported greater improvements in suicidal ideation and mental health distress compared to participants who received treatment as usual (TAU). Here, we explored moderators and mediators of the effectiveness of CAMS. Compared to TAU, CAMS was more effective in reducing suicidal ideation when the working alliance, in particular its bond subcomponent, was low. In terms of reducing mental health distress, CAMS was superior to TAU only for participants who did not use illicit drugs and, more tentatively, only for patients without borderline personality traits. We suggest that CAMS may repair a difficult vantage point in terms of poor working alliance in patients with suicide ideation. To obtain superior benefits of CAMS upon more general mental health distress in patients with drug abuse or borderline traits, these problems may need to be more explicitly targeted in parallel.

Behavior change techniques for increasing physical activity in cancer survivors: a systematic review and meta-analysis of randomized controlled trials

Purpose

The purpose of this systematic review and meta-analysis is to investigate how physical activity (PA) can be effectively promoted in cancer survivors. The effect of PA-promoting interventions in general, behavior change techniques (BCTs), and further variables as moderators in particular are evaluated.

Methods

This study included randomized controlled trials of lifestyle interventions aiming at an increase in PA that can be carried out independently at home, published by December 2016, for adults diagnosed with cancer after completion of the main treatment. Primary outcomes were subjective and objective measures of PA prior to and immediately after the intervention. Meta-analysis and meta-regression were used to estimate effect sizes (ES) in terms of standardized mean differences, variation between ES in terms of heterogeneity indices (I²), and moderator effects in terms of regression coefficients.

Results

This study included 30 studies containing 45 ES with an overall significant small positive effect size of 0.28 (95% confidence interval=0.18–0.37) on PA, and I²=54.29%. The BCTs Prompts, Reduce prompts, Graded tasks, Non-specific reward, and Social reward were significantly related to larger effects, while Information about health consequences and Information about emotional consequences, as well as Social comparison were related to smaller ES. The number of BCTs per intervention did not predict PA effects. Interventions based on the Theory of Planned Behavior were associated with smaller ES, and interventions with a home-based setting component were associated with larger ES. Neither the duration of the intervention nor the methodological quality explained differences in ES.

Conclusion

Certain BCTs were associated with an increase of PA in cancer survivors. Interventions relying on BCTs congruent with (social) learning theory such as using prompts and rewards could be especially successful in this target group. However, large parts of between-study heterogeneity in ES remained unexplained. Further primary studies should directly compare specific BCTs and their combinations.

EEG asymmetry at 10 months of age: are temperament trait predictors different for boys and girls?

Frontal EEG asymmetry patterns represent markers of individual differences in emotion reactivity and regulation, with right hemisphere activation linked with withdrawal behaviors/emotions (e.g., fear), and activation of the left hemisphere associated with approach (e.g., joy, anger). In the present study, gender was examined as a potential moderator of links between infant temperament at 5 months, and frontal EEG asymmetry patterns recorded during an Arm Restraint procedure at 10 months of age. Positive Affectivity/Surgency (PAS), Negative Emotionality (NE), and Orienting/Regulatory Capacity (ORC) were considered as predictors, with PAS emerging as significant for males; higher levels translating into greater right-frontal activation later in infancy. For females, ORC accounted for a significant portion of the frontal asymmetry scores, with higher ORC being associated with greater right-frontal activation. The moderating influence of gender noted in this study is discussed in the context of implications for discrepancies in rates/symptoms of psychopathology later in childhood.

Heuristics and biases: interactions among numeracy, ability, and reflectiveness predict normative responding

In Stanovich's (2009a, 2011) dual-process theory, analytic processing occurs in the algorithmic and reflective minds. Thinking dispositions, indexes of reflective mind functioning, are believed to regulate operations at the algorithmic level, indexed by general cognitive ability. General limitations at the algorithmic level impose constraints on, and affect the adequacy of, specific strategies and abilities (e.g., numeracy). In a study of 216 undergraduates, the hypothesis that thinking dispositions and general ability moderate the relationship between numeracy (understanding of mathematical concepts and attention to numerical information) and normative responses on probabilistic heuristics and biases (HB) problems was tested. Although all three individual difference measures predicted normative responses, the numeracy-normative response association depended on thinking dispositions and general ability. Specifically, numeracy directly affected normative responding only at relatively high levels of thinking dispositions and general ability. At low levels of thinking dispositions, neither general ability nor numeric skills related to normative responses. Discussion focuses on the consistency of these findings with the hypothesis that the implementation of specific skills is constrained by limitations at both the reflective level and the algorithmic level, methodological limitations that prohibit definitive conclusions, and alternative explanations.

Mindfulness may both moderate and mediate the effect of physical fitness on cardiovascular responses to stress: a speculative hypothesis

The psychological construct of mindfulness refers to an awareness that emerges by intentionally paying attention to the present experience in a non-judgmental or evaluative way. This particular quality of awareness has been associated to several indicators of physical and psychological health, and can be developed using mindfulness-based interventions (MBIs), and therefore MBIs have been successfully applied as preventive and complementary interventions and therapies in medicine and psychology. Together with quiet sitting and lying meditation practices, mindful physical exercises such as “mindful walking” and “mindful movement” are key elements in MBIs and couple muscular activity with an internally directed focus, improving interoceptive attention to bodily sensations. In addition, MBIs seem to share similar mechanisms with physical fitness (PF) by which they may influence cardiovascular responses to stress. Based on these facts, it is feasible to raise the question of whether physical training itself may induce the development of that particular quality of awareness associated with mindfulness, or if one's dispositional mindfulness (DM) (the tendency to be more mindful in daily life) could moderate the effects of exercise on cardiovascular response to stress. The role of mindfulness as a mediator or moderator of the effect of exercise training on cardiovascular responses to stress has barely been studied. In this study, we have hypothesized pathways (moderation and mediation) by which mindfulness could significantly influence the effects of PF on cardiovascular responses to stress and discussed potential practical ways to test these hypotheses.

Cultural Beliefs, Intimate Partner Violence and Mental Health Functioning among Vietnamese Women

Intimate partner violence (IPV) against women occurs in all countries, with wide-ranging negative effects, including on mental health. IPV rates vary widely across countries, however, suggesting cultural factors may play a role in IPV. The primary purpose of the present study was to assess relations among IPV, mental health symptoms, and cultural beliefs among Vietnamese women, focusing on moderator effects of cultural beliefs on relations between IPV and mental health. IPV, anxious and depressive mental health symptoms, and culturally-related beliefs about IPV were cross-sectionally assessed in 105 married adult Vietnamese women randomly selected from public population registries in five provinces. IPV was significantly correlated with anxiety, depression, and suicidal ideation. Relations were moderated by wives' culturally-related beliefs about abuse (e.g., relations between IPV and mental health symptoms were smaller for women who believed that nothing could be done about abuse). Findings suggest that when attempting to prevent or treat effects of IPV, it will be important to consider that certain beliefs about IPV generally viewed as maladaptive (e.g., nothing can be done about abuse) may have adaptive effects, at least in the short-term, on relations between IPV and mental health functioning.

A simple statistic for comparing moderation of slopes and correlations

Given a linear relationship between two continuous random variables X and Y that may be moderated by a third, Z, the extent to which the correlation ρ is (un)moderated by Z is equivalent to the extent to which the regression coefficients β_y and β_x are (un)moderated by Z iff the variance ratio σy2∕σx2 is constant over the range or states of Z. Otherwise, moderation of slopes and of correlations must diverge. Most of the literature on this issue focuses on tests for heterogeneity of variance in Y, and a test for this ratio has not been investigated. Given that regression coefficients are proportional to ρ via this ratio, accurate tests, and estimations of it would have several uses. This paper presents such a test for both a discrete and continuous moderator and evaluates its Type I error rate and power under unequal sample sizes and departures from normality. It also provides a unified approach to modeling moderated slopes and correlations with categorical moderators via structural equations models.

Adolescent problem behavior in Nairobi's informal settlements: applying problem behavior theory in sub-Saharan Africa

Adolescent involvement in problem behaviors can compromise health, development, and successful transition to adulthood. The present study explores the appropriateness of a particular theoretical framework, Problem Behavior Theory, to account for variation in problem behavior among adolescents in informal settlements around a large, rapidly urbanizing city in sub-Saharan Africa. Data were collected from samples of never married adolescents of both sexes, aged 12-19, living in two Nairobi slum settlements (N = 1,722). Measures of the theoretical psychosocial protective and risk factor concepts provided a substantial, multi-variate, and explanatory account of adolescent problem behavior variation and demonstrated that protection can also moderate the impact of exposure to risk. Key protective and risk factors constitute targets for policies and programs to enhance the health and well-being of poor urban adolescents in sub-Saharan Africa.

Parents' Campaigns to Reduce their Children's Conduct Problems: Interactions with Temperamental Resistance to Control

Longitudinal studies have found associations between parenting and the development of conduct problems, and have found that resistant to control temperament moderates these associations. Intervention studies have found associations between intervention-induced changes in parenting and subsequent reductions in children's conduct problems. However, no study to date has evaluated whether parents' self-initiated efforts to change their parenting practices affect children's conduct problems and whether effects depend on children's temperament. The current study asked whether parents' concerted efforts, or campaigns, to increase their involvement and limit-setting were effective in reducing growth in conduct problems from late childhood to early adolescence. It also asked whether the effects of campaigns varied according to children's levels of temperamental resistance to control. Analyses statistically controlled for parenting practices and conduct problems before the campaigns, socioeconomic status, gender, and ethnicity. Results indicated that campaigns that included increased involvement and limit-setting were beneficial only for youths who were rated in early childhood as temperamentally resistant to control.