Lecture Notes 12th and 14th
Lecture Notes 12th and 14th 76884
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This 11 page Class Notes was uploaded by Rachel Onefater on Thursday April 14, 2016. The Class Notes belongs to 76884 at George Washington University taught by Dr. George Howe in Spring 2016. Since its upload, it has received 11 views. For similar materials see PSYC4201W in Psychlogy at George Washington University.
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Date Created: 04/14/16
How do you pick and choose what to pull from studies that are relevant. Describing a Research Question *NOTE: Asking to be clearer so the reader understands what you are trying to say Does movement relieve stress? What do you mean by this question? Does dancing relieve stress? What kind of dance genre, setting, muscle tension? Does regular dancing relieve stress?What does regular mean? Does regular dancing relieve anxiety? When? Does daily dancing reduce anxiety in college students who are consistently exposed to higher levels of daily stressors in the last 4 weeks of the semester? Next step: Literature Search *NOTE : says something about it, and: a. if there are not many studies out there, you can do something more basic, b. but if there are you can be more specific Evidence Related to the Research Question Citation: (West, Otte, Geher, Johnson, & Mohr, 2004) Method: R ed: relevant/important → Did not explain counterfactual or a control group 1. 69 Healthy College Students 2. Participated in one of three 90 minute classes: hatha yoga,African Dance, Biology Lecture 3. There were 18 in the yoga class, 21 in the dance class, and 30 in the lecture lass 4. Participants were not randomly assigned to classes 5. All classes took place between 4 to 6pm to control for Circadian rhythm of cortisol. 6. Participant were asked to spit four times at 1 min. Interval to collect saliva before and after class. 7. Salivary cortisol was measured by utilizing a onesite chemiluminescence immunometric assay involving competitive inhibition 8. Affect was measured in the 20 item Positive Affect and Negative Affect Schedule (PANAS) before and after class. Results: 1. Both African dance and hatha yoga showed significant reduction in negative affect 2. These were both significantly larger that f biology clas, in which negative affect did not change significantly 3. There was no significant difference in negative affect between African Dance and Hatha Yoga 4. Salivary cortisol increase significantly for African dance, decrease significantly for Hatha yoga, and remained unchanged for biology 5. Cortisol changes for dance were significantly different from those of yoga and biology class which did not differ from each other. → Cortisol is an index of stress response How is this study relevant for the research question? One of the limitations of this study is that the assessment for the effect may include anxiety and other things. Some Evidence is not consistent for our hypothesis, but there is no ful measure of anxiety, so the measure of negative affect is only a partial measure. a. The control(i.e. bio class) can increase anxiety and not really be a control group. i. Boring lecture, lecture that has a lot of pressure There is some evidence that dance may influence negative affect in college students. West, Otte, Geher, Johnson and Mohr, 2004 assigned 69 college students to African dance yoga or to a biology lecture. They found that those in the dance condition reported decreases in negative affect compared to those in biology class. However, the study did not randomly assign people to condition, reducing confidence in the findings. In addition, the measure of negative affect was not limited to anxiety, but included items relevant for depression, anger, and other negative affects. Citation: Pinniger et al. Reference: Brauninger 2012 Dance therapyin 9 cities, they randomizes different people in either dance movement therapy or in the control, but they only pulled this off in 9 of the city’s. When you drop people because of low participation effect, there is a decrease in confidence for the results. Constructing a hypothesis Hypotheses: are concrete statements about the world 1. They are based on currently available limited evidence 2. They make claims about cause and effect 3. It is a starting point for further exploration 4. Clear, precise, hypotheses guide us in designing the methods necessary for testing. Hypothesis : “Undergraduate students who are exposed to high levels of daily stressors during the last four weeks of the semester, and who participate in semi weekly dance class during those four weeks ,will show less increase or greater reduction in anxiety as compared to students assigned to a waitlist control condition.” Writing for your reader 1 Use the aci Nonnormative Lifecourse Transitions •NonNormative transitions : Those that are unpredictable, not expectable, and possibly uncommon • Examplesmajor shifts in one's world and have long lasting implication, and if that transition is stressful, it can lead to a cascade of stressors and lead to decline in various areas of health. – Divorce – Death of a parent – Disabling illness – Forced emigration *NOTE: stressors can also be considered life transitionsNormative(def.) within the norm, within the average of where most people will go 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 cryinthings 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! Different grief trajectories • George Bonnano → Grief trajectories – Resilience: 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: 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: suffering and inability to function that continues for several years/Complicated Bereavement/Grief(another term for this) – Delayed trauma : 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. 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. *** 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.) Developmental cascades •Kendler et al (2002): cascade of factors associated with adult depression in Virginia Twin data Family conflict loss and sexual abuse and risk how do they have their impact? Implications for prevention •Suggests targeting both individual and family processes •Intervention soon after loss could help reduce effects across childhood and into adulthood Prevention programs for families undergoing such transitions • Irwin Sandler and Charlene Wolchik, Arizona State University: developed and tested two programs – Family Bereavement Program (FBP) – New Beginnings Program for divorced families 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 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 girl→ 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 girl→ externalizing means becoming more aggressive Mediation? • Did changes in targets lead to changes in outcomes? • Tein et al (2006) Mediation of the Effects of the Family Bereavement Program on Mental Health Problems of Bereaved Children and Adolescents. • Tested mediation for girls in sample • Several target variables mediated impact of FBP on mental health: – Increased positive parenting – Decreased inhibition of emotional expression – Increased positive coping by youth – Decreased negative appraisal of stressors – Decreased unknown control beliefs 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.
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