Cognitive defusion versus experiential avoidance in the reduction of smoking behaviour: an experimental and preliminary investigation

Background: Brief procedures that reduce smoking behaviour may be useful in reaching the many people that do not seek help for smoking addiction.

Objectives: The current study aimed to determine if one component of Acceptance and Commitment Therapy (ACT), cognitive defusion, could be useful in reducing smoking behaviour in a sample of students.

Methods: The study employed a between-subjects three-arm design. For one week, participants were asked to reduce their cigarette consumption. To aid them in their reduction, participants were randomly allocated to one of three conditions: the first received a defusion procedure, the second received an experiential avoidance procedure and a control condition received no procedure. For a second week, the instruction to reduce cigarette consumption was lifted. During both weeks participants were required to monitor their smoking behaviour via a tally diary system.

Results: The defusion condition smoked significantly less than the control condition during week one and significantly less than the control and experiential avoidance conditions during week two.

Conclusion: Results are discussed in terms of the potential utility of defusion in this domain, and the limitations of this preliminary research that would need to be addressed in future investigations.     

老年冠心病PCI术后患者目标承诺、应对方式在家庭功能与感知控制间的中介作用

目的 分析老年冠心病经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后患者目标承诺、应对方式在家庭功能与感知控制之间的中介作用.方法 采用一般资料调查表、修订版控制态度量表(Control Attitudes Scale-Revised,CAS-R)、家庭关怀度指数...     

Extended Outpatient Civil Commitment and Treatment Utilization

Summary

Objective: This study considers four hypotheses regarding the impact of extended involuntary outpatient commitment orders on services utilization.

Method: All Victorian Psychiatric Case Register (VPCR) patients who had extended (180+ day) outpatient commitment orders in the nine year study period and a matched treatment compliant comparison group with extended periods of outpatient care (N = 1182), both with at least two years of post-episode experience, were evaluated. Pre/post episode utilization was compared via paired t tests with individuals as their own controls. Logistic and OLS regression as well as repeated measures ANOVA via the GLM SPSS program and post hoc t tests were used to evaluate between group and across time differences.

Results: Extended episodes of care for both groups were associated with reduced use of hospitalization and increases in outpatient services. Extended orders did not promote voluntary participation in the post-period. Outpatient services during the extended episode for those on orders were raised to the level experienced by the treatment compliant comparison group and maintained at that level via subsequent renewal of orders throughout the patients' careers. OLS regression results indicate that approximately six community care service days were required for those on orders to achieve a one-day reduction in hospital utilization following the extended episode.

Conclusion: Outpatient commitment for those on extended orders in the Victorian context enables a level of community-based services provision, unexpected in the absence of this delivery system, which provides an alternative to hospitalization.     

家长式领导对公立医院员工创新行为影响的实证研究

目的：探讨家长式领导对公立医院员工创新行为影响的作用机制。方法：采取整群随机抽样方法,对北京市5所三级甲等医院的325名员工应用家长式领导量表、组织承诺量表、医院员工创新行为量表进行横断面问卷调查。结果：（1）仁慈领导与德行领导对医院员工创新行为有显著正向影响;（2）威权领导对医院员工创新行为具有显著负向影响;（3）仁慈领导与德行领导对医院员工创新行为具有显著的正向交互作用;（4）组织承诺在仁慈领导、德行领导、威权领导对员工创新行为的影响中发挥部分中介效应。结论：医院管理者应采取或借鉴仁慈领导行为和德行领导行为,提高员工的组织承诺水平,为员工创新行为提供必要的支持。     

Strengthening vaccination policies in Latin America: An evidence-based approach

Despite many successes in the region, Latin American vaccination policies have significant shortcomings, and further work is needed to maintain progress and prepare for the introduction of newly available vaccines. In order to address the challenges facing Latin America, the Commission for the Future of Vaccines in Latin America (COFVAL) has made recommendations for strengthening evidence-based policy-making and reducing regional inequalities in immunisation. We have conducted a comprehensive literature review to assess the feasibility of these recommendations. Standardisation of performance indicators for disease burden, vaccine coverage, epidemiological surveillance and national health resourcing can ensure comparability of the data used to assess vaccination programmes, allowing deeper analysis of how best to provide services. Regional vaccination reference schemes, as used in Europe, can be used to develop best practice models for vaccine introduction and scheduling. Successful models exist for the continuous training of vaccination providers and decision-makers, with a new Latin American diploma aiming to contribute to the successful implementation of vaccination programmes. Permanent, independent vaccine advisory committees, based on the US Advisory Committee on Immunization Practices (ACIP), could facilitate the uptake of new vaccines and support evidence-based decision-making in the administration of national immunisation programmes. Innovative financing mechanisms for the purchase of new vaccines, such as advance market commitments and cost front-loading, have shown potential for improving vaccine coverage. A common regulatory framework for vaccine approval is needed to accelerate delivery and pool human, technological and scientific resources in the region. Finally, public–private partnerships between industry, government, academia and non-profit sectors could provide new investment to stimulate vaccine development in the region, reducing prices in the long term. These reforms are now crucial, particularly as vaccines for previously neglected, developing-world diseases become available. In summary, a regionally-coordinated health policy will reduce vaccination inequality in Latin America.     

Religious Faith and Transformational Processes in Marriage

Leading scholars of marital processes strongly recommend supplementing the current focus on marital conflict to include research on transformative processes. This qualitative study examines the connection between religion and the transformative processes of commitment and coping in marriage. The sample for this study includes 184 married couples (N = 368 individuals), making it far larger than most in‐depth, qualitative interview‐based studies. Participants included Christians, Jews, and Muslims with an over sampling of minorities and immigrant families living in all eight regions of the United States. For several decades studies have shown a largely positive correlation between (a) religiosity and marital commitment and (b) religiosity and (generally) positive coping, but with little explanation regarding how and why. Findings of this study indicate that there are specific religious beliefs and practices related to how these couples approach their marriages—including several that relate to the two transformative processes of commitment and coping.     

Adult Work Commitment,Financial Stability,and Social Environment as Related to Trajectories of Marijuana Use Beginning in Adolescence

ABSTRACT. Background: The objective of this study is to examine trajectories of marijuana use among African Americans and Puerto Ricans from adolescence to adulthood, with attention paid to work commitment, financial stability, drug use, and violence. Methods: Participants (N = 816) completed in-class questionnaires as students in the East Harlem area of New York City at the first wave and provided follow-up data at 4 additional points in time (mean ages = 14, 19, 24, 29, and 32 years). Among 816 participants, there were 60% females, 52% African American, and 48% Puerto Ricans. Results: The chronic marijuana user trajectory group compared with the none or low, increasing, and/or moderate marijuana user trajectory group was associated with negative aspects of work commitment, financial stability, and the social environment. The chronic marijuana user group was similar to the increasing marijuana user group on work commitment and financial stability. Conclusions: These results suggest that treating marijuana use in late adolescence may reduce difficulty in the assumption of adult roles. Because chronic marijuana users experienced the most adverse effects in each of the domains, they require more intense clinical intervention than moderate marijuana users.     

A Stage I pilot study of acceptance and commitment therapy for methadone detoxification

Background

While agonist replacement therapies are effective for managing opioid dependence, community treatment programs are increasingly choosing detoxification. Unfortunately, success rates for opioid detoxification are very low, in part, due to physical and psychological symptoms associated with opioid withdrawal. Few behavior therapies specifically address the distressing experiences specific to opioid withdrawal. A novel behavioral treatment, acceptance and commitment therapy (ACT), works from the premise that the avoidance of unpleasant private experiences (thoughts, feelings, bodily sensations) is ubiquitous yet may be pathogenic, resulting in treatment drop-out and further drug use.

Methods

This Stage I pilot study developed and tested an ACT-based opioid detoxification behavioral therapy. Opioid dependent patients (N = 56) who were attending a licensed methadone clinic were randomized to receive either 24 individual therapy sessions of ACT or drug counseling (DC) in the context of a 6-month methadone dose reduction program.

Results

While no difference was found on opioid use during treatment, 37% of participants in the ACT condition were successfully detoxified at the end of treatment compared to 19% of those who received DC. Fear of detoxification was also reduced across time in the ACT condition relative to DC.

Conclusion

This first study of ACT to assist opioid detoxification indicates promise. Research is needed to refine specific treatment strategies for this population to further strengthen effects.     

Pregnancy Loss and Distress Among U.S. Women

Although pregnancy loss—especially miscarriage—is a relatively common experience among reproductive‐aged women, much of our understanding about the experience has come from small clinic‐based or other nonrepresentative samples. We compared fertility‐specific distress among a national sample of 1,284 women who have ever experienced a stillbirth or miscarriage. We found that commitment/attachment to pregnancy that ended in loss as well as current childbearing contexts and attitudes were associated with distress following pregnancy loss. Practitioners working with women or couples who have experienced pregnancy loss should be aware of the importance of characteristics associated with higher distress, such as whether the pregnancy had been planned, recency of the loss, no subsequent live births, having a medical explanation for the loss, a history of infertility, current childbearing desires, importance of motherhood, and locus of control over fertility.