Final Study Guide
Final Study Guide 76884
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This 23 page Study Guide was uploaded by Rachel Onefater on Monday April 25, 2016. The Study Guide belongs to 76884 at George Washington University taught by Dr. George Howe in Spring 2016. Since its upload, it has received 70 views. For similar materials see PSYC4201W in Psychlogy at George Washington University.
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Date Created: 04/25/16
1. • Cognitive reappraisal: (def.)if we are in a stressful situation, if we interpret it in one way, we may have greater emotional response – Changing an emotional response be reinterpreting the meaning of a situation • Example: I was let go from my job without explanation; → it must be because I’m not good at what I do VS. → I was let go from my job without explanation; later I checked with my old co-workers and they told me that my whole division was eliminated, so I know it didn’t have anything to do with my competence Appraisal: This negative event occurred because something occurred in the external world, and not in something internal→ There is an overgeneralization in self-blame(first appraisal) 2. Expressive writing and reappraisal • Jamie Pennebaker Social PsychologySurveys – Early studies found those who had disclosed a traumatic event to others had better health than those who did not. Are traumatic events associated with health? Q: Is there something that is just about expressing what is going on that influences our health – Theorized that merely writing about event would relieve stress and improve health Testing effects of expressive writing 3. Identitybased motivation theory (IBM): we think about ourselves and form schemas about the world and ourselves, and it is a much bigger picture view of who we are. Who am I, what is the concept of who I am. → Our self-concepts are not necessarily singular, unilateral concepts of who we are, they are rather multi-faceted, and involve identities in particular context, past, current, or future identities – Our self concepts are multifaceted, and include a range of past, current, and future identities – We construct identities “on the fly”, depending on the situation – We are motivated to act in ways congruent with our currently activated identities 4. Oyserman & Destin (2010): “Consider an eighth grader whose selfconcept, sampled across multiple contexts, includes the following identities: “I am a girl whose parents are from Mexico. I used to want to play violin. I hate school. This coming year, I expect to get As and be really popular. I want to become a doctor. I am afraid I might end up poor, unemployed, or homeless.” → We interpret difficulty differently depending on the situation Example: If you hate school and you are asked to solve a problem on the board, it is difficult because it cannot be changed, but if you like school, your inability to solve a problem can be fixed/helped, and it can be seen as more of a motivational factor. 5. Program components • Group classroom intervention to build peer support for possible identities • Discussion of range of adult possible identities using familiar photos • Focus on negative forces and possible setbacks, emphasizing overcoming of obstacles • Timelines into the future, to tie current and future identities together • Focus on developing specific strategies to move towards future identities → Results • Changes in targeted mediators: (changes in possible selves) – Feared offtrack possible selves (drugs, gangs, delinquency) → Starting to understand what affects it would have in the future. Intervention actually increased their awareness on off-track identities – Balance in expected (“passing 8th grade”) and feared (“having to repeat grade”) possible selves – Plausibility of possible selves (number of possible selves, range of strategies) • Mediated impact on school and mental health outcomes up to 2 years later → intervention influence people's plausible identities, reported more strategies, and influence balanced, and specific targets in the cognitive realm fit, and up to two years later, there were effects in reducing classroom behavior problems, absences, homework etc. 6. The three waves of CBT • First wave: change behavior : reinforcement schedules, learn skills, and mold skills to be better • Second wave: change thoughts: Changing content of thoughts, and how you think, and challenging that • Third wave: attend to experiences, change how we respond to our thoughts 7. Cognitive restructuring: (def.) therapeutic activities that lead people to learn how to challenge irrational thoughts and cognitive distortions – Learning to identify and challenge “irrational or maladaptive thoughts”, also known as cognitive distortions 8. Risk Factors: ● Attachment to the conceptualized self → We think abstractly about who we are, rather than experiencing things in the present moment ● Dominance of the conceptualized past and feared future → We attend to concepts about the past and abstracts fears of the future ● Cognitive Fusion → We focus on attention on the contents of our minds(thoughts, beliefs) rather than what we are experiencing with the 5 senses → Thought seem like the absolute truth, what you have to obey 9. Correlation: is another way to determine how two variables are related. In addition to telling you whether variables are positively or inversely related, correlation also tells you the degree to which the variables tend to move together. Covariance: indicates how two variables are related. A positive covariance means the variables are positively related, while a negative covariance means the variables are inversely related. 10. If the correlation between recent stressors and depression symptoms is .42, the results are inversely related( as one variable increases, the other decreases and vice versa), however because the correlation is less than .5, they are not statistically significant enough to reach a conclusion about the relationship between the two variables. 11. Problemfocused coping • Approach activities – I just concentrated on what I had to do next – I made a plan of action and followed it – I changed something so things would turn out all right. – I knew what had to be done, so I doubled my efforts to make things work. • Avoidance activities – I slept more than usual – I generally avoided being with people – I wished that the situation would go away or somehow be over with Emotionfocused coping • Selfsoothing – I listen to music – I get a massage – I go for a run or other exercise – I express my emotions creatively (i.e. painting) • Seeking emotional support from others – I go out with a friend – I share my troubles with another – I talk to someone who can empathize – I let others know how bad I feel about things 12. Problems with this framework: mixed findings • Problemfocused approach coping was usually associated with better emotional response (such as less depression or anxiety) – In couples facing prostate cancer – In dementia caregivers (Piercey et al., 2013) • But occasionally it was not – In people recently diagnosed with low grade brain tumors (Keeling et al, 2013) • Avoidant coping was most often associated with more negative emotional response (such as more depression or anxiety) – In couples facing prostate cancer – In dementia caregivers (Piercey et al., 2013) • But distancing or distraction, originally thought to be forms of avoidance, were sometimes associated with better outcomes – Reduced children’s perceptions of pain (Lu et al, 2007)this situation was actually helpful • Although not in all situations – In children of highconflict parents, distancing associated with more anxiety and depression, (Fear et al., 2009) • Emotionfocused coping was often associated with greater distress – Associated with suicidal ideation in: • Adult medical inpatients (Marusic & Goodwin, 2006) • Undergraduate women (Edwards & Holden, 2001) • Italian adolescents surviving a major earthquake (Stratta et al, 2014) – Associated with greater anxiety or depression in • Couples facing prostate cancer in men (Lafaye et al, 2014) • First nation adults in Canada (mediated effects of childhood trauma) (McQuaid et al., 2014) – Although sometimes it was associated with lower distress: expressive writing(Pennebaker et.al) 13. Studying effects of personality style • Bolger & Zuckerman (1995) – Included a measure of Neuroticism, defined as • A broad dimension of personality • whereby people vary in autonomic nervous system lability(def.) it changes fast, it can “bounce around” • and in the tendency to experience negative emotionsassociated with things like anxiety and depression – Allowed them to assess whether effects were different for those higher or lower in neuroticism Findings: stress exposure • Conflict on any day was associated with increases in anger, depression, not anxiety, the next day • But only for the high N group • For low N group, some evidence for recovery next day (negative association) **Changes in anger go up the next day after a conflict, but do not change for the other group. For depression they found it going up for the high neuroticism group(p=.054→ “fuzzy”) and low neuroticism is negative Findings: coping • High “N”(neuroticism) group engaged in more – Planful problem solving – Selfcontrolling – Seeking social support – Escapeavoidance – Confrontation (marginally) • Effects of coping on change in emotion depended on type of coping, type of emotion, and level of neuroticism → Self-controlling coping was involved in increasing anger the next day → High N also increase depression N the next day, and those in Low N, depression went down the next day 14.Other situations where attempts at active control may lead to negative emotions • John Weisz (1994): studied children being treated for leukemia, who were exposed to: – Staying in the hospital overnight – Lumbar punctures – Bone marrow aspiration – Procedures leading to vomiting and hair loss Control versus adapting or giving up • Weisz asked children to describe goals, and what they did to cope with each of these. 3 general responses: – To change environment – To adjust self (beliefs, hopes, goals, interpretations) to circumstance – To relinquish control (“there’s nothing I can do’) Distress for different types of coping with medical procedures → For those kids that said they do something about it, coming up on the the situation, they were more distressed than children who gave up or said they would adjust, and was the opposite effect after the treatment 15.Behavioral activation therapy for depression – Addis & Martel (2004) – Overall Strategy: ACTION • Assess behavior/mood, and see how you respond! • Choose alternate responses, • Try out those alternate responses, • Integrate these alternatives, and keep doing them until they feel second nature! • Observe results and (Now) evaluate *NOTE: Often, certain responses lead to avoidance – Tracking behavior and mood, to identify TRAPs • Triggers(identify) • Responses(observe) • Avoidance Patterns *Asked people to keep logs and what may have triggered or came before the action! – Replace with TRAC • Trigger • Response • Alternate Coping response Efficacy in treatment of depression • Mazzucchelli et al (2009) – Metaanalysis of 34 studies with 2005 participants – Effective at posttest, 13 month followup (few studies follow longer) – No differences when compared to other treatments, esp. CBT(3040 different types of behavioral activation, yes this does help) → There are very few studies that follow up after the three months → After CBT, longer term effects for CBT for depression that reduce the likelohood of the depression to arise again → impossible to do intervention without using messages to change how they view the world and how it affects their lives: Impact on Appraisal 16.Partial correlation: the degree of association between two variables with the effects of one or more other variables removed 17.Regression coefficient: ○ The association between an independent and dependent variable ○ Where the effects of all other independent variables are controlled ○ Scaled as the amount that the dependent variable increases for each unit increase in the independent variables ○ Note: the value will not be the same as that for the partial correlation, which has been standardized differently, but significance levels will be identical 18.Social interactions that increase stress response • Social exclusion/rejection: deliberate exclusion of individual from social interaction or relationship → A.K.A Shunning/ignore their existence for some time(term coined in the Middle Ages) • Social evaluation: a negative evaluative judgment shared and communicated by others → These are not independent of each other--someone rejected or excluded from a group may also feel judged • Critical attack: Direct communication that one is deficient or devalued. Example: You left your nail clippings in the sink. You are an asshole! a. Extreme form: psychological or emotional abuse. • Physical attack: Slapping, hitting, choking, attacking with a weapon 19.Manipulation check: students reported more negative and less positive affect following both conditions. 20. Appears to be particularly strong in adolescence • Stroud et al (2009) Stress response and the adolescent transition: Performance versus peer rejection stressors. • Compared children (712) with adolescents (1317) in two tasks Performance stress (public speaking, mental arithmetic) Peer rejection (being excluded when with two others) 21. Effects on various biological markers of stress response • Performance stress led to more cortisol responsewith HPA axis may take longer • Rejection stress led to more blood pressure responsedirect response to the sympathetic nervous system/increase in b.p. suggests increase in activation of the sympathetic nervous system(i.e. adrenaline) • Effects stronger for adolescents *NOTE: Social exclusion may lead to immediate reactivity whereas performance stress may have slower results, but may last longer 22. Lifetime prevalence of depression, anxiety disorders • Green et al. (2010) Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey Replication I: Associations with first onset of DSMIV disorders. → anything above 100%(i.e. average) means you have an increased risk for these disorders neglect and sexual abuse have the highest rate for having depression 23. Cycles of interaction in close relationships • Close, stable relationships – Parent and child – Longstanding friendships – Workplace collaborations – Intimate partners • Behavior in such relationships is more(when compared to casual interactions): – Interdependent (each person’s actions can influence both people’s goals) → Situations where my behavior not only influence my goals, but also your goals, and your behavior influences your goals and my goals – Mutually influential (each person’s behavior influences how the other person acts) – Cyclic (dyads develop repetitive cycles of interaction) → we fall into patterns, and we are less flexible when we fall into certain patterns of interaction 24.– Validation: supportive statements of caring, valuing, and concern for the other – Invalidation: critical, hostile, blameful, or attacking statements 25.– Withdrawal or avoidance: changing the subject, denying responsibility, stonewallingnot responding when someone wants a response from you • Some cycles more likely to increase stress: – Invalidation cycles: reciprocal blaming and attack – Demandwithdraw cycles: one person demands change, the other avoids or withdraws 26. • Distressed couples engaged in more demandwithdraw cycles, particularly when discussing relationship problems→ blaming, “you” for relationship problems even though relationships involve two people. • Men more likely to withdraw, women to demand, but more balanced for personal problems, in nondistressed marriages Social relationships as protective? **NOTE: When compared to nondistressed couples 27.Lakey’s Relational Regulation Theory – Rather, relating to others helps us regulate our emotions, thoughts, and actions during hard timesClose relationships involve mutual regulation 28. • Goal support: activities by other that support personal goals, or meaningful objectives people pursue in daily life. • Brunstein et al (1996) Personal Goals and Social Support in Close Relationships: Effects on Relationship Mood and Marital Satisfaction. – Studied couples – Found that receiving goal support from partner was associated with marital satisfaction, and this was amplified by awareness of the other’s goals – Stronger effects for women 29.• Support Equity or reciprocity: balance of giving and receiving – Too much of either can feel aversive – Those in support groups who reported the most benefit also felt they provided equitable support in return (Cohen) 30.Trials: a research method for testing the impact of interventionsa method for testing a program or specific prevention Prevention Programs Treatment Programs 31.•Test efficacy(1): does the program lead to the desired change? –Prevention: reduction in future prevalence of some physical or mental health problem (i.e. may not be able to test it right away because you want to see if it has long term effects.) –Treatment: resolution or cure of an existing problemDo want to take a look at immediate effects of the treatment and/or longterm cure •Test comparative efficacy(2): if we have two programs for the same condition, which one works better?More focused Trials (Ex: Antidepressant medication has a stronger or weaker impact on depression) •Test differential efficacy(3): Does a program work better for some people than for others? •Testing mechanism of effect(4): Does the program work by changing specific targets (risk, protective, maintenance mechanisms)? Ex: Someone in the midst of a major depressive episode, and what are the things that are maintaining it, and if you do change those things, does that change the effect of the depression? 32. Pretest/Posttest Without Control GroupStrengths •Trials that evaluate change in target or outcome after intervention •But have no comparison group Ex: develop intervention for school system and collect data in the beginning and end of year strong at math or mindfulness skills, but you don’t have comparison group Problems with Pretest/Posttest without ControlWeaknesses ● Very weak design ● Cannot rule out alternative causes of naturally occurring change such as: ○ Participants seeking out other treatments or resources during the study ○ Natural recovery in highly symptomatic groups ○ Development 33. Nonrandomized Comparison Group DesignStrengths •Compare those receiving intervention to other existing groups that do not receive intervention •Select comparison groups to be as similar as possibleto make all other causes equal •But no random assignment to the two conditions Problems with nonrandomized comparison group designWeaknesses •Cannot rule out alternative causes that differ between the two groups: –Selection effects (very few juniors opted to provide data) –Naturally occurring changes (juniors may have increased demands compared to seniors) –Development: seniors may be in different developmental period when more change occurs •Can be improved by assessing possible confounds to determine if groups differ on them –In this study, no differences on current or past meditation or yoga practice 34.Randomized Group Comparison Designs •For treatment, referred to as randomized clinical trials (RCT) •Strengths of random assignment: –Greatly increases likelihood that groups are equivalent on plausible confounds, even when those are unknown •Challenges: –May not be able to have control over assignment process 35.•Intenttotreat design –Keep random sampling the same –Collect outcome data on everyone, including those who fail to attend intervention –Analyze complete sample •Strengths –Eliminates this source of selection bias, maintaining randomization •Weaknesses –Effects could be diluted because not everyone gets full “dose” of intervention –May therefore require larger samples to detect effect 36.WaitList Control •Variant of no treatment control –Half the sample randomly assigned to wait for treatment –Collect pretest, posttest on full sample during waitlist period •Strengths: –May be more attractive to participants –People consider lotteries for limited resources to be fair, and so may be able to get permission for random assignment more easily •Weaknesses: –Cannot conduct longerterm followup within randomized framework 37. •Control condition: relevant counterfactual is being exposed only to messages that increase expectations of success (also known as placebo control) –Differs on exposure to all elements of the intervention –Similar on messages of likely effectiveness 38.–These are an indivisible element in many interventions •Control condition: relevant counterfactual is being exposed only to equivalent amount of social contact and support (sometimes called nonspecific factors) –Differs on exposure to all elements of the intervention –Similar on amount of contact and support 39.•Control condition: relevant counterfactual is being exposed only to equivalent amount of other treatments or services: treatmentasusual (TAU) control –Potential confound here: assignment to experimental condition may reduce use of TAU services –If this happens, experimental group differs in two ways (more experimental treatment, less usual treatment) 40.Comparative Efficacy •Testing whether one intervention is better than another •Sometimes referred to as “headtohead” designs •Random assignment to two different interventions –With control group –With no control group Example: Head to Head with Control •Foa et al. (1991) study of treatment for PTSD in rape victims •Random assignment to three intervention and one wait list control group •Allows tests of: –Individual efficacy (each intervention compared to control) –Comparative efficacy (each intervention versus each other intervention) •Comparative efficacy findings: –Stress inoculation had strongest effects at posttest –Prolonged exposure had strongest effects at followup Head to Head Without Control •Design: random assignment to either of two interventions, but no control group •Problem: even if treatment A is better than treatment B, cannot distinguish from: –Treatment A is not effective, and treatment B leads to significant negative impact –Treatment A has some negative impact, and treatment B has even more negative impact •Recommended only when there are enough prior trials demonstrating the both treatments show effects when compared to control 41.• Olds et al (1986). Preventing child abuse and neglect:A randomized trial of nurse home visitation. • Small urban area in northern New York • Randomized 400 women to two different interventions – Prenatal screening services – Screening services plus nurse visitation program • Collected data at posttest, and continued to follow for 15 years Findings • Over first four years, NFP group showed: – Significantly fewer subsequent pregnancies – Greater participation in work force Tracked interactions with childprotective services, and did not find any effects here Findings • Over 15 years: NFP group showed: – Lower rates of child protective services reports of abuse or neglect *NOTE: If neglect does exist, it does start at about age 5(age at first neglect) Zielinski et al (2009) Highestrisk group • More pronounced differences in highest risk group (lowest SES, single parent) Zielinski et al (2009) → 14% rate of neglect in the intervention group and 35% of Mothers was reported for neglect in the control group. → Eternalizing Disorder like ADHD, Social Conflict and/or aggressiveness in children. Early intervention can be really helpful → Did a tremendous amount of work to see if the staff was trained in the way that they needed to be, and if they were actually doing what they were supposed to be doing. 42.• Moderator hypothesis: Does it have different impact for different families? There may be a cause that is more relevant with some groups than with others. • Mediation hypothesis: If so, does it do so by changing social risk and protective mechanisms (family communication)? What did you change early on that brought that final outcome/change about. • Do effects differ for families who begin with poor parentadolescent communication? • Moderator Hypothesis: – Those with poor communication will do better because the program is designed to help them – Those who begin with good communication will not benefit as much because they don’t need the intervention • Measured parentadolescent communication prior to random assignment • Internalizing symptoms assessed 24 times, with 12 36 month follow ups Findings • Baseline target levels moderated intervention effects→ the better the families did, the less those kids changed. Parent-Adolescent communication is actually an active moderator. – Those low on target at baseline showed greatest reduction in internalizing; those high on target showed no effects 43. SpeakerListener Rules • Rules for both: – The Speaker is the one with the floor. – Share the floor back and forth. – Explain and seek to understand each other's priorities. – The Speaker can pass the floor at any time to the Listener to hear their side of an issue. a. Speaker Rules • Don't go on and on. • After saying a bit, pause and let the Listener check out what he or she understood. • Speak for yourself; explain why something is important for you. b. Listener Rules • Listen for why things are important for the Speaker. • Every so often check out your understanding of what the Speaker means. • Ask for examples or explanations of what the Speaker said. • Don't offer your own opinions or thoughts until you get the floor. • Concentrate on what the Speaker is saying, and try to "edit out" your own internal responses. 44.Randomized trial of PREP • (Markman et al, 1988) . Prevention of marital distress: A longitudinal investigation. – Randomly assigned 42 couples planning to marry to PREP or no intervention control – PREP involved 5 couples group sessions, focusing on: • Communication skills training • Problem solving training • Clarification of marital expectations • Sexual/sensual education and relationship enhancement – Collected data at posttest and across next 5 years Effectiveness of PREP • Up through 4 year followup, those in PREP showed: • Better communication skills (people rated their discussions as effectiveness of communication). • Better conflict management skills • More support and validation • Better problem solving • Fewer divorces (though difference is not significant) • Evidence of reduced physical violence → Did not put people in the study who were “at risk”, and this was conducted on a normative sample. *NOTE: this study is not relevant today because of increase in access to technology, different gender roles( i.e. homosexual relationships, feminism movement). 45. Evaluating intervention components • Dismantling design: Comparing effects of full intervention with individual components – Tests whether individual components differ in their overall impact – Can also test whether individual components influence different targets – Test whether the full intervention increases efficacy over individual components 46. Analysis of variance • Analysis of variance: a method of testing whether variability among means differs from zero • We can calculate a variance for the set of group means • We can calculate a standard error for that variance • We can use this to test whether the variance is far enough away from zero to conclude that it is not due to chance • Calculating standard error of variance among means is complex; depends on – Variance among the means – Variance within each group contributing a mean 47.• One solution: Bonferroni correction (more conservative approach) – Determine number of comparisons, divide p value threshold by that number – This gives a new p value threshold for significance → Correct the threshold value for saying if something is significant or not. Divide .05 by the number of comparisons you are going to do! 48.• Principles of MBSR – Intentionality(def.) need to form an intention, selfmotivating – Paying attention (def.) a focus – In the present moment – With an attitude of acceptance, curiosity, self compassion, and openness (def.) not about fate, but to accept what come without being entrapped by that thoughtbeing fused with your thoughts – In meditation, and in everyday life 49. The ABC approach to stress • Awareness – Notice your stress signs – Identify your stressors • Breath and beliefs – Feel your breath and body – Reframe beliefs about the stress or stressor • Choice – Accept situation or – Change situation 50. Intervention effects on social anxiety • Both CBT and MBSR significantly reduced anxiety compared to waitlist, and both maintained effects • No differences between CBT and MBSR *NOTE: results suggest that these have efficacy MBSR effects on targets • MBSR significantly changed all targets except attention shifting MBSR: did targets mediate effect on anxiety? • MBSR showed mediation through six of eight targets CBT effects on targets • CBT significantly changed all targets CBT: did targets mediate effect on anxiety? • CBT showed mediation through all targets Differences? • MBSR and CBT equally effective at changing all targets except: – CBT slightly stronger on decreasing subtle avoidance behavior – Mediating effects of reappraisal efficacy and subtle avoidance a bit stronger for CBT 51. Loss of a parent during childhood • The natural course of bereavementgrieve – Many reactions are similar to those in depression • Crying, sadness • Thinking and talking about the loss • Problems sleeping, eating • Problems with attending or focusing – But there is no single common pattern • Bonanno’s “coping ugly”: responses that seem counterintuitive, but are healthy: laughter, celebration, lack of cryingthings that would seem to be antithetical to have lost someone, and we have to be careful in response to people who react in these ways! 52. Different grief trajectories • George Bonnano → Grief trajectories – Resilience(1): maintaining stable, healthy levels of functioning, and the capacity for positive emotions people seem to be doing fine, and may have periods of grief. – Recovery(2): reactions that continue for several months, and gradually give way to normal functioningsignificant experiences of bereavement, but gradually gave way for normal functioning. – Chronic dysfunction(3): suffering and inability to function that continues for several years/Complicated Bereavement/Grief(another term for this) – Delayed trauma(4): normal adjustment, but symptoms surface months later (mainly related to traumatic loss) Example: the person died in a sudden accident, or a person whose loved one died from a violent suicide or homicide. 53.Complicated grief • Ongoing, heightened state of mourning • Symptoms (Mayo Clinic website): • Intense sorrow and pain at the thought of your loved one • Focus on little else but your loved one's death • Extreme focus on reminders of the loved one or excessive avoidance of reminders • Intense and persistent longing or pining for the deceased • Problems accepting the death • Numbness or detachment • Bitterness about your loss • Feeling that life holds no meaning or purpose • Irritability or agitation • Lack of trust in others • Inability to enjoy life or think back on positive experiences with your loved one ***Difference between Grief and Depression?: Whenever you diagnose depression, you would drop that diagnosis if a person had a recent loss, having a recent loss would rule out depression from DSM’s IIV. Recent research has a difficult time separating these out now, originally dropped it and just said it was depression, but because of the huge objection they got from Prof., they kept it in the DSM V. *** 54. Prevalence in bereaved youth? • Melhem et al. (2011)Grief in children and adolescents bereaved by sudden parental death. • Followed youth aged 718 for two years after loss of parent. • Assessed complicated grief three times (9, 21, 33 months after loss) • Found evidence for three stable trajectories: 59% had grief response started with some grief response and it sort of stayed they way, 31% had a strong grief response and it stayed that way 3 years out, 10% had very extreme grief response, and it stayed that way three years later. Risk for depression? • Also assessed presence of major depressive disorder • Complicated bereavement class predicted depression trajectories → (table in the PP) % of people who have had a major depressive episode immediately afterwards, does not show people who did not experience a loss and suffered from depression Related to type of loss? • Brent et al. (2012) Longitudinal effects of parental bereavement on adolescent developmental competence. • Followed 176 offspring aged 725 who had lost parents, along with 186 comparison youth • Parental suicide particularly predictive → Everyone who lost someone has a higher risk for depression after three years, and risk is particularly high for a parent who has committed suicide. Circumstances surrounding the loss has an impact on susceptibility for depression. Longterm risk? • Kendler et al. (2002) Childhood parental loss and risk for firstonset of major depression and alcohol dependence: The timedecay of risk and sex differences. • Interviewed 7188 adults from Virginia Twin Registry • Collected data on: • Loss of parent in childhood due to either death or separation • Major depressive disorders (lifetime) • Alcohol abuse disorder (lifetime) Predicted trajectories: loss at age 10 •Effect of maternal death is initially stronger, for both males and females •Effect of maternal separation is more moderate, but lasts much longer •Loss of either parent in either way has long term effects on alcohol use, but only for females 1. Depression following maternal death at age 10→ huge increase in risk from loss to no loss(13 times) 2. Depression following maternal separation at age 10→ effects are stable and much more lasting suggesting that separation may not have an immediate impact, increases with 3. Alcohol abuse following any type of loss→ stays up throughout the course of the life, but only for females. Why? • Loss itself may change the child→ What it would carry through childhood, adolescence and then in later adulthood *NOTE: Every see has every gene, but the cells don’t come out the same. Sets of cells have genes that are changed and have little bits of methyl groups that are added to them and stop working. A huge number of genes get turned off or muted. • Tyrka et al (2012) Childhood adversity and epigenetic modulation of the leukocyte glucocorticoid receptor: preliminary findings in healthy adults. • Study of 94 adults – Retrospective recall of loss or separation in childhood – Assessment of methylation of glucocorticoid receptor gene • Loss associated with more methylation of GR gene (involved in HPA axis response) • However, very preliminary: – Few studies – Much variability – Problem of retrospective report – Mixes together loss and separation • Loss also changes the child’s world – Mental health of surviving parent – Cascade of changes following change in financial circumstance – Change in interactions between child and surviving parent, with cascade of developmental effects on the kids(i.e. parent and kid interaction is not as good as it was before.) 55. Targets in the Family Bereavement Program • Parent factors – Positive relationship between caregiver and child→ 50% of children who lost a parent no longer lived with their living biological parent. – Mental health of the caregiver – Serious conflicts between caregivers and children – Encouraging caregivers not to involve children in stressors that were primarily the caregivers’ responsibility (e.g., financial troubles) → Many parents begin to confide in their children with things they should not be concerned with. – Effective discipline • Child factors – Positive selfesteem – Adaptive beliefs about why negative events occur – Active inhibition of expressing feelings – Positive coping strategies – Perceptions of control 56. FBP components • Format – 8 separate group meetings for children, adolescents, caregivers – 4 conjoint group meetings (caregivers and youth together) – 2 family meetings • Caregiver group topics – Improving positive interactions with youth, effective discipline – Challenging negative self thoughts – Increasing positive activities(which often fade away during this time because of parental grief and depression) – Reducing child exposure to caregiver’s issues (such as finances) • Youth group topics – Expression and validation of griefrelated feelings – Cognitive reframing – Distinguishing controllable from uncontrollable events – Problemsolving Trial of Family Bereavement Program • Sandler et al (2003) The Family Bereavement Program: Efficacy evaluation of a theorybased prevention program for parentally bereaved children and adolescents. • Sample – Recruited from community through schools, churches, hospitals, newspaper articles, media presentations – Recruited 244 children/adolescents aged 816 in 189 families – Had experienced death of parent no less than 4 or more than 30 months ago • 67% due to illness • 20% accident • 13% suicide or homicide – No one currently in mental health treatment *NOTE: Can we use this to prevent the onset or occurrence of things later on • Design – Randomly assigned families to one of two conditions: • FBP • Self study program (3 books sent monthly to caregivers and youth) along with a study guide – Program fidelity • Wrote a manual for all group leaders to follow will have specific kinds of activities and processes discussed • Videorecorded groups, used independent raters to assess completion of specific action items (8590% coverage) to check if basic action steps were taken during the intervention Participation and intenttotreat • FBP Participation rates – Parents: 88% attendance – Children and adolescents: 85% attendance • Intenttotreat design – After assignment to condition, everyone kept in the study, regardless of participation rate – Eliminates selection effects due to lack of participation Success of randomization? • Tested whether groups differed on 30 variables measured at pretest (demographics, targets, outcomes) • Found significant differences (at .05 level) for 2: – During observed parentyouth interactions, FBP group families showed more positive affective tone, attending behavior Multiple sources, times of measurement • Collected data on targets and outcomes at – Pretest – Posttest – 11 month follow up – 6 year follow up • Used interview, selfreport from both caregivers and youth, as well as teachers • Also had caregivers and youth discuss common problems – Videorecorded interactions – Systematically rated behavior Effects on targets at 11 months • Child targets – FBP reduced negative appraisals for new stressors for girls who started with more negative appraisal – Increased positive coping for girls→ not for the boys so gender is moderating(moderator effect) more effect at 11 months for girls. • Parenting targets – FBP led to more authoritative parenting (warm, engaged, appropriate discipline) Effects on outcomes at 11 months • Intrusive grief thoughts: FBP reduced for both boys and girls • Mental health: Moderated by gender and baseline severity – FBP reduced anxiety/depression for girls – FBP reduced anxiety for those who started with more severe symptoms (boys and girls) – FBP reduced externalizing symptoms for girls→ externalizing means becoming more aggressive Effects of FBP 6 years later: • Sandler et al (2010) LongTerm Effects of the Family Bereavement Program on Multiple Indicators of Grief in Parentally Bereaved Children and Adolescents. • Problematic grief: still lower for FBP (twice as many fell below clinical cutoff in FBP compared to control) – FBP reduced social detachment and insecurity particularly for boys • Appraisal: Stronger coping efficacy (impact goes through parenting) • Active coping: Increased active and decreased avoidant coping (impact goes through parenting) • Parenting: Effects on appraisal and coping operate through increased parental acceptance, decreased rejection; not through changes in discipline *NOTE: had to do with more acceptance and less rejectioncascade of effects and helping families stabilize and help parent and kids back in sync and allows kids to develop the skills later to decrease grief. Summary • “Gold standard” elements for prevention trials – Broad sampling – Randomization to program and control – Use of manualized intervention – Methods for testing fidelity – Intenttotreat design to eliminate selection effects – Multiple sources of measurement including direct observation – Testing for group equivalence on pretest characteristics – Longitudinal follow up over several years – Testing impact on targets as well as outcomes – Testing whether change in targets mediates effects on outcomes *NOTE: Only study of its type up to date in this area that has been conducted→ early phase with these sorts of studies. 57.• For the average causal effect to be valid, we must assume: – Each person in the study will follow the same causeeffect process, regardless of the condition they are assigned to – Also called the causal invariance assumption 58.– When this assumption is not valid, we have effect heterogeneity What if this assumption is wrong? • Example: studying social rejection and cortisol response • Randomly assign youth to social rejection or socially neutral interaction, and measure change in cortisol • What if it is the case that: – Women are aware of social rejection cues – Men are clueless Possible outcome: • Social exclusion challenge: strong increases on cortisol for women, little for men (Class 10B) Stroud et al (2002) 59. What if we didn’t look for that difference? • Average change greatly underestimates the effects for women, and assumes effects for men when they aren’t there • That is, effect is heterogeneous It can get worse! • Example: randomized intervention trial testing effects of program on reducing stress response • Finds mean differences favoring treatment Opposite effects for men and women • Yet, women show positive impact, but men show negative impact of intervention Summary • Violations of the causal invariance assumption lead to distorted results • A good idea to test for effect heterogeneity, particularly if there is evidence or theory supporting its existence 60.• Known as test of external validity: testing whether causal impact is invariant across the entire population of interest (in this case both men and women) 61.Issues in external validity • Will depend on the population we wish to study. – If we are only interested in mechanisms relevant for college students, we don’t need samples of the elderly – If we are interested in everyone in the US, we need to think about the whole range of development, contexts • Effect heterogeneity can occur across: – People – Places – Times 62. However… • All the moderators so far (gender, genes, perceived control, family communication) were not randomly assigned • Moderator effects can also be confounded Example • Suppose the Familias Unidas study reported the following baseline scores (these are simulated): • Do we really know that family communication, and not youth gender or some other variable, was the actual moderator? • Remember, family communication level was not randomly assigned • Need to consider (and adjust for) confounders here as well Summary • External validity of a study depends on: – The population of interest – How much the sample matches that population – Particularly on potential moderators • Even if the sample reflects the population, effect heterogeneity can bias results unless we account for it directly through moderator analyses • Moderator effects can be confounded, so it is important to check for confounding here as well as when looking at causes
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