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Cognitive processes mediating behavioral change.

The present experiment was designed to test the theory that psychological procedures achieve changes in behavior by altering the level and strength of self-efficacy. In this formulation, perceived self-efficacy. In this formulation, perceived self-efficacy influences level of performance by enhancing intensity and persistence of effort. Adult phobics were administered treatments based upon either performance mastery experiences, vicarious experiences., or they received no treatment. Their efficacy expectations and approach behavior toward threats differing on a similarity dimension were measured before and after treatment. In accord with our prediction, the mastery-based treatment produced higher, stronger, and more generalized expectations of personal efficacy than did the treatment relying solely upon vicarious experiences. Results of a microanalysis further confirm the hypothesized relationship between self-efficacy and behavioral change. Self-efficacy was a uniformly accurate predictor of performance on tasks of varying difficulty with different threats regardless of whether the changes in self-efficacy were produced through enactive mastery or by vicarious experience alone.

Adolescent↗

The effects of changing the phase and duration of sleep.

The relative effects of extended sleep, reduced sleep, and shifts of habitual sleep time on subsequent performance and mood were studied. Ten healthy male university students who regularly sleep 9.5-10.5 hr were the subjects. Measurements were obtained from a 45-min auditory vigilance task, a 5-min experimenter-paced addition task and a mood adjective check list 30 min after awakening, at midday, and in the evening following five electroencephalographically recorded nights of sleep. The experimental treatments compromised at 9.5-10.5 hr habitual sleep condition and four conditions in which the regular sleep period was lengthened, reduced, delayed, and advanced by 3hr. Following each 3-hr altered condition of sleep there was an equivalent decline in vigilance performance and in subjective arousal as measured by the mood scales. Together with other recent evidence, the present results support the hypothesis that acute disruption of the 24-hr sleep-wakefulness cycle produces degradations in human performance largely independent of total sleep time.

Arousal↗

An analysis of the professional performance of physician's assistants.

The job performance of a national sample of 939 physician's assistants has been assessed by means of a self-rating scale as well as by a rating scale completed by supervising physicians. Three-quarters of the participating supervising physicians are greatly satisfied with the work of their physician's assistants and a similar proportion indicate that they would definitely hire the same assistant if they "had it to do over again." The influences of background and work environment characteristics upon performance were assessed by means of multiple regression. Graduating from a military-sponsored physician's assistant program appears to have a beneficial effect upon performance. Performance during training exerts only a weak effect upon job performance. Amount of education and medical experience prior to beginning physician's assistant training do not affect job performance.

Clinical Competence↗

Age factors in patient-therapist relationship.

This paper reports on the effects of therapist and patient age as factors in the evaluation and treatment of adult psychiatric outpatients. Therapist ratings and patient self-ratings are contrasted in three age groups. Rating scales include symptomatology, motivation, insight, and prognosis. In addition, a chart review follow-up of 68 patients includes disposition and drop-out. The data suggest that older patients are perceived as sicker, but less treatable than younger patients or patients of the same age group as the therapist. Residents express a strong preference for treating younger patients, but more readily develop a treatment relationship with same age patients. Both older and younger patients were significantly less likely to remain in treatment. Age of therapist and patient as a significant, frequent unrecognized factor in psychotherapeutic intervention is discussed and modifications in psychiatric training programs are suggested.

Adjustment Disorders↗

Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation.

Two groups of young, healthy, nonathletic volunteers were subjected to selective sleep stage deprivation. Six subjects were deprived of stage 4 sleep and seven subjects of REM sleep. The stage 4 deprived group reported more musculoskeletal symptoms during the deprivation condition than did the REM deprived group. The stage 4 deprived group also showed a significant increase in muscle tenderness between the baseline and deprivation conditions and an altered pattern of overnight change in muscle tenderness in response to deprivation. The REM deprived group did not show either of these changes. These results are discussed in the light of the previously postulated relationship between NREM sleep disturbance and muscoloskeletal pain in patients with so-called "Fibrositis syndrome."

Adult↗

Sleep disorder and psychobiological symptomatology in male psychiatric outpatients and male nonpatients.

Sleep disturbance was studied in relation to psychiatric and physical symptoms for 214 male psychiatric outpatients and 248 male nonpatients. Our self-report instrument required that subjects describe the frequency of symptoms precisely on a five-point scale from "every day" to "not at all." Percentages are based on the numbers of subjects reporting a symptom as occurring "every day" or "several times a week." More patients reported sleep disturbance symptoms (75%) than nonpatients (25%) (P less than 0.001). Sleep loss symptoms were reported by 63% of patients and 20% of nonpatients. Twelve percent of patients and 6% of nonpatients reported trouble with excessive sleep problems. Sleep disturbance was not strongly related to specific diagnoses. Fewer schizophrenics (21%) than other patients (50%) reported trouble "falling asleep" (P less than 0.02). Finally, for both patients and controls, disturbed sleepers reported more psychiatric and physical symptoms than undisturbed sleepers (P less than 0.001). It is suggested that sleep disturbance might be a useful clinical clue to previously unsuspected psychiatric and physical illness.

Adult↗

Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia.

The authors compared the sleep laboratory recordings of 122 drug-free subjects who complained of chronic insomnia with the subjects' estimates of their habitual sleep characteristics and their estimated sleep time on the morning after sleeping in the laboratory. Most subjects consistently underestimated the amount of time they slept and overestimated the amount of time it took them to get to sleep in comparison with laboratory data. All subjects consistently underestimated the number of arousals they experienced. The authors discuss the implications of these findings for the treatment and definition of insomnia and for further research.

Adolescent↗