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PubMed2002

Cognitive-behavioral treatment of high anger drivers.

Relaxation and cognitive-relaxation interventions were compared to a no treatment control in the treatment of high anger drivers. The cognitive portion of the cognitive-relaxation condition adapted the style of Beck's cognitive therapy, particularly use of Socratic questions and behavioral experiments and tryouts, to driving anger reduction. Both interventions lowered indices of driving anger and hostile and aggressive forms of expressing driving anger and increased adaptive/constructive ways of expressing driving anger. The cognitive-relaxation intervention also lowered the frequency of risky behavior. Both interventions lowered trait anger as well. Limitations and implications for treatment and research were discussed.

Adaptation, Psychological↗
PubMed1997

Measurement of antecedents to drug and alcohol use: psychometric properties of the Inventory of Drug-Taking Situations (IDTS).

The development, factor structure, and validity of the Inventory of Drug-Taking Situations (IDTS) is described. This 50-item self-report questionnaire, which is an extension of the Inventory of Drinking Situations (Annis, 1982. Inventory of drinking situations; Annis, Graham & Davis, 1987, Inventory of drinking situations (IDS): User's guide), is designed to assess the situational antecedents to use of a wide range of drugs of abuse. The IDTS consists of 8 subscales that measure a client's substance use in the 8 situations identified in the work of Marlatt (1978, Alcoholism: New directions in behavioral research and treatment): Unpleasant Emotions, Physical Discomfort, Pleasant Emotions, Testing Personal Control, Urges and Temptations to Use, Conflict with Others, Social Pressure to Use, and Pleasant Times with Others. Reliability, factor structure and validity of the IDTS were assessed on 699 clients admitted to the Addiction Research Foundation's treatment facility in Toronto. The IDTS was shown to have reliable subscales. The IDTS total score correlated with self-ratings of the severity of the clients' substance use problem, and with retrospective reports of frequency of use (drugs) and quantity of use (alcohol), years of usage, and severity of dependence. Confirmatory factor analysis was used to test the fit of the data to Marlatt's model of substance use situations, as well as to several alternative models. The goodness-of-fit indicators suggested that the best fit for the data was an 8-factor model corresponding to the 8 subscales based on the Marlatt categories. Evidence was presented that the 8 subscales can be further grouped into 3 second-order factors: (1) negative situations, (2) positive situations, and (3) temptation situations. The negative situation subscales of Unpleasant Emotions, Conflict with Others and Physical Discomfort were found to be correlated with the SCL-90R Depression scale. Interpersonal Sensitivity scale and Somatization scale respectively. The positive social situation subscales of Pleasant Times with Others and Social Pressure to Use were found to be negatively correlated with percentage of time using alone, and positively correlated with pressure from friends and family to use. On the States of Change Readiness and Treatment Eagerness Scales (SOCRATES), clients at the precontemplation stage of change had relatively flat, undifferentiated IDTS profiles (i.e. little scatter of subscale scores), whereas clients in the determination stage had the most differentiation in their IDTS subscale scores. Excellent comparability was found for alcohol clients between the IDS and the IDTS. Evidence was also presented for adequate comparability between the computer and paper and pencil administrative formats of the IDTS.

Adult↗
PubMed1997

Motivation and glycemic control in diabetes mellitus.

Although adherence to treatment regimes is clinically important in diabetes mellitus, the best way to improve it is unclear. As a precursor to evaluating the place of a brief intervention (motivational interviewing) in the treatment of diabetes, this study investigated the relation between motivation and glycemic control in 361 diabetic out-patients. Outcome measures were the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and HbA1C level--a measure of glycemic control. The majority of patients (86.7%) could be allocated to a single motivational stage, indicating that this concept is applicable in the study of diabetes. There were significant associations between HbA1C level and motivational stage, but not in the direction predicted. That is, patients at an earlier motivational stage had lower HbA1C levels than those at later stages. The results suggest that feedback of HbA1C level may partly determine the patient's motivation to control their diabetes, although the effect is quite weak.

Adolescent↗
PubMed2002

Apoptosis: a guide for the perplexed.

The term 'apoptosis' describes an active process of cellular deconstruction originally contrasted morphologically with necrosis. The mistaken equivalence of the terms apoptosis and 'programmed cell death' has caused confusion and implied that apoptosis is an identifiable therapeutic target rather than a name of a type of cell death. The roots of confusion are suggested to lie not in superficial disagreements about the morphology and biochemistry of cell death, but in the lamentable disconnection of modern science from its philosophical foundations (i.e. Socratic definition, nominalism versus realism, and William of Ockham's advocacy of Aristotelian metaphysics over Plato's Theory of Forms). Renewed awareness of these issues might be the key to understanding that apoptosis is a created concept, not a real entity, and that the use of terms that defy definition has become an obstacle to clear thinking about preventable cell death.

Apoptosis↗
PubMed1998

Enhancing motivation for change in treatment-resistant eating disorders.

Denial and resistance to change are prominent features in most patients with anorexia nervosa. The egosyntonic quality of symptoms can contribute to inaccuracy in self-report, avoidance of treatment, difficulties in establishing a therapeutic relationship, and high rates of attrition and relapse. Individuals with bulimia nervosa are typically more motivated to recover, but often ambivalent about forfeiting the ideal of slenderness and the protective functions of binge-purge behavior. Few attempts have been made to assess denial and resistance in the eating disorders, or to examine alternative strategies for enhancing motivation to change. Review of the clinical literature indicates a striking convergence of recommendations across conceptually distinct treatment approaches. Clinicians are encouraged to acquire a frame of reference that can help them understand the private experience of individuals with eating disorders, empathize with their distress at the prospect of weight gain, and acknowledge the difficulty of change. The Socratic method seems particularly well-suited to work with this population because of its emphasis on collaboration, openness, curiosity, patience, focused and systematic inquiry, and individual discovery. Four themes are crucial in engaging reluctant eating-disordered clients in therapy: the provision of psychoeducational material, an examination of the advantages and disadvantages of symptoms, the explicit use of experimental strategies, and an exploration of personal values.

Attitude of Health Personnel↗
PubMed2003

The role of relevancy in normative feedback for university students' drinking patterns.

OBJECTIVE: Intervention studies using normative feedback have reported changes in motivation for changes in alcohol use. The relevancy of the social comparison group of the feedback has not yet been examined. The purpose of this study was to examine whether varying the relevancy of the comparison group would result in greater motivation for changes in alcohol use. METHOD: Participants completed the AUDIT and then read one of three intervention pamphlets: (i) Canadian population drinking patterns; (ii) Canadian university students' drinking patterns; or (iii) American university students' drinking patterns. Afterwards, participants completed the recognition and ambivalence subscales of SOCRATES and rated their overall impressions of the pamphlet. RESULTS: Participants identified as problem drinkers who read the American university students pamphlet reported significantly higher recognition ratings, compared to problem drinkers who read one of the other two pamphlets. CONCLUSIONS: Explanations for the unanticipated findings are discussed. The authors speculate that participants may have relied on their knowledge of perceived drinking patterns as opposed to relevancy of the feedback in making their social comparison.

Adult↗
PubMedDate not supplied

Development and validation of the drug-taking confidence questionnaire: a measure of coping self-efficacy.

The Drug-Taking Confidence Questionnaire (DTCQ; Annis & Martin, 1985) is a 50-item self-report questionnaire developed to assess situation-specific coping self-efficacy for use of a particular substance of abuse (e.g., cocaine, heroin, alcohol, cannabis, etc.). Results from exploratory and confirmatory factor analyses of the DTCQ on 713 clients seeking treatment at an addiction treatment facility provided strong evidence for the situation-specificity of efficacy beliefs. An 8-factor first-order model, based on the eight high-risk categories for relapse identified by G.A. Marlatt (Marlatt & Gordon, 1980) and a 3-factor second-order model (i.e., negative situations, positive situations, and temptation situations) provided the best fit to the data. All eight subscales of the DTCQ were shown to have good reliability (alphas .79 to .95). Extensive convergent and discriminant validity analyses for the DTCQ and its subscales in relation to ADS, DAST, OES, DRIE, SCQ, SCL-90R, BDI, HS, and SOCRATES substantiate that the DTCQ is a promising tool for further research and clinical application.

Adaptation, Psychological↗
PubMed2003

Developments in the screening for Chlamydia trachomatis: a review.

Many studies have evaluated selective screening criteria for women in various settings. Most have concluded and all guidelines recommend that all women aged < 25 be screened yearly for C. trachomatis infection. Behavioral criteria, such as the number of sex partners, new or more than one sex partners, and previous infection, also can serve as criteria for screening women aged > 25. Because re-infection rates are high and occur within a few months, complications may be reduced further if partners are treated and women rescreened 4 to 6 months after initial infection. Revised recommendations for C. trachomatis screening programs have stated that more frequent screening may be considered among women < 20 and those with recent infection. Screening in nontraditional settings and careful evaluation of local prevalence and risk factor information should be encouraged. Private providers and emergency room providers should discuss screening recommendations and adopt a C. trachomatis screening policy for the population they serve. The HEDIS measure should serve to encourage at least annual screening of 15- to 25-year-old sexually active females through providers linked to managed care organizations. In general, high yields (ie, percentage of tests that are positive) in nontraditional settings and enhanced feasibility and acceptability of urine-based tests may encourage further innovative approaches to reach and screen populations at risk. Several issues remain to be addressed to increase the effectiveness of screening efforts. If more sensitive amplification tests are used widely, more infected persons will be identified and treated, and transmission patterns may change, particularly if partner treatment also occurs. Current screening criteria should continue to be re-evaluated. An important issue that affects testing methods includes the possible need for confirmation testing when using NAATs if the prevalence of C. trachomatis is less than 2%. If the sensitivity of an NAAT is 85% and specificity is 99%, in a hypothetical population of 10,000 with a prevalence of 2%, the positive predictive value is 170/268 (63%). A second important issue affecting testing methods and feasibility of using NAATs for screening large numbers of individuals is the pooling of urine specimens, which has been evaluated in several studies and found to be very effective for reducing costs. A research issue for pooling is the determination of the most cost-effective prevalence levels for pooling. An additional research question is in which populations should a NAAT be used for detection of C. trachomatis and N. gonorrhoeae. There are no recommendations for the routine screening of men because of the paucity of data showing that this strategy can reduce sequelae. The CDC is conducting a multisite study to examine the feasibility, acceptability, and usefulness of screening of asymptomatic men. There are a few studies have determining cost-effective prevalence threshold levels, particularly with NAATs. A recently developed decision analysis model by CDC designed to maximize the effectiveness of screening strategies for C. trachomatis infections may be useful for decision makers. It is intended to serve as an easy and flexible tool to determine cost effectiveness at a local level and takes into account positivity rates and test performance characteristics (SOCRATES). It is unclear if recurrent infection is caused by true re-infection by the same or a different partner or recurrence of initial infection. Recurrence may be caused by persistence of C. trachomatis or antibiotic resistance. This distinction is of scientific interest because the appropriate intervention differs (eg, identification of risk factors for the former and microbiologic investigations for the latter). Effective partner management and retesting are critical to reducing sequelae of C. trachomatis infection. Screening for C. trachomatis infection remains an essential component of C. trachomatis control. It is cost effective, most infections are asymptomatic, and symptom-based health care seeking and testing identify few of those infected. The likelihood that opportunities for screening are missed is high particularly in non-STD clinic settings. Local studies using NAATs to determine C. trachomatis prevalence and risk factors are helpful to health care providers so they can make evidence-based decisions on who to screen. The use of nontraditional, non-clinic-based test settings should be explored further. We have focused on summarizing the medical evidence regarding recommendations for screening for C. trachomatis. High-risk populations for C. trachomatis infection may overlap with populations for other STDs, and comprehensive STD prevention programs that involve a range of STD service providers are needed to successfully reduce the STD-related health burden in the population.

Chlamydia Infections↗
PubMed2000

Decentring and distraction reduce overgeneral autobiographical memory in depression.

BACKGROUND: Increased recall of categorical autobiographical memories is a phenomenon unique to depression and post-traumatic stress disorder, and is associated with a poor prognosis for depression. Although the elevated recall of categorical memories does not change on remission from depression, recent findings suggest that overgeneral memory may be reduced by cognitive interventions and maintained by rumination. This study tested whether cognitive manipulations could influence the recall of categorical memories in dysphoric participants. METHODS: Forty-eight dysphoric and depressed participants were randomly allocated to rumination or distraction conditions. Before and after the manipulation, participants completed the Autobiographical Memory Test, a standard measure of overgeneral memory. Participants were then randomized to either a 'decentring' question (Socratic questions designed to facilitate viewing moods within a wider perspective) or a control question condition, before completing the Autobiographical Memory Test again. RESULTS: Distraction produced significantly greater decreases in the proportion of memories retrieved that were categorical than rumination. Decentring questions produced significantly greater decreases in the proportion of memories retrieved that were categorical than control questions, with this effect independent of the prior manipulation. CONCLUSIONS: Elevated categorical memory in depression is more modifiable than has been previously assumed; it may reflect the dynamic maintenance of a cognitive style that can be interrupted by brief cognitive interventions.

Adult↗
PubMed2004

Rediscovering the meaning in medicine: lessons from the dying on the ethics of experience.

Modern medicine is currently confronting a crisis of meaning that is manifesting in a dispirited and demoralized profession. Palliative medicine and the care of patients with incurable diseases provide clinicians with an opportunity to rediscover the meaning in their work. In particular, with its emphasis on compassion, palliative medicine reconnects us to the Socratic ideal and an "ethics of experience." Our rediscovery of this perennial philosophy is necessary if we are to develop the wisdom necessary to containing our enormous scientific capabilities.

Attitude to Death↗
PubMed1979

A problem-oriented analysis of database models.

Which is the most convenient database model considering specific applications? The goal of this paper is to try to answer this question by the use of a chemical example. Examples of requests describe the problems of insertion, deletion, and updating; these requests are analyzed for the hierarchical model and are expressed in a relational language defined by the authors and in Socrate for the network model.

Chemical Phenomena↗
PubMed1998

Some philosophies can console: an old but forgotten message.

Thesis: Since Socrates, western philosophy has been concerned with the study of humankind, with a strong emphasis on how we ought to live and why. Philosophy, in its multiple forms and expressions, has enabled many to pursue their lives with greater depth, richness, and variety; yet it can also act as a therapeutic method for the achievement of a healthier life. Asking and answering philosophical questions such as 'How best ought I live?', 'What is the meaning of my life in relation to the whole?', 'Why should I live?', 'What constitutes a healthy life?' can act as therapeutic entryways, not only within the parameters of one's own mind or in a university classroom, but also within a health care/therapy context. Philosophy, both as subject and method, is a powerful, largely unrecognized, therapeutic instrument for social medicine, an instrument whose application in various health care settings could benefit those--patient and staff--in need of consolation and support when they need it most.

Existentialism↗
PubMed2001

Autonomy and dependence: chronic physical illness and decision-making capacity.

In this article some of the presuppositions that underly the current ideas about decision making capacity, autonomy and independence are critically examined. The focus is on chronic disorders, especially on chronic physical disorders. First, it is argued that the concepts of decision making competence and autonomy, as they are usually applied to the problem of legal (in)competence in the mentally ill, need to be modified and adapted to the situation of the chronically (physically) ill. Second, it is argued that autonomy and dependence must not be considered as two mutually exclusive categories. It is suggested that decision making may take on the form of a more or less conscious decision not to be involved in making all kinds of explicit and deliberate decisions. Elaborating on Agich's distinction between ideal and actual autonomy, the concept of "Socratic autonomy" is introduced.

Chronic Disease↗
PubMed2003

Ethical case deliberation on the ward. A comparison of four methods.

The objective of this article is to analyse and compare four methods of ethical case deliberation. These include Clinical Pragmatism, The Nijmegen Method of ethical case deliberation, Hermeneutic dialogue, and Socratic dialogue. The origin of each method will be briefly sketched. Furthermore, the methods as well as the related protocols will be presented. Each method will then be evaluated against the background of those situations in which it is being used. The article aims to show that there is not one ideal method of ethical case deliberation, which fits to all possible kinds of moral problems. Rather, as each of the methods highlights a limited number of morally relevant aspects, each method has its strengths and weaknesses as well. These strengths and weaknesses should be evaluated in relation to different types of situations, for instance moral problems in treatment decisions, moral uneasiness and residue, and the like. The suggestion arrived at on the basis of the findings of this paper is a reasonable methodological plurality. This means that a method can be chosen depending on the type of moral problem to be deliberated upon. At the same time it means, that by means of a method, deliberation should be facilitated.

Communication↗
PubMed2003

Multilevel selected primary prevention of child maltreatment.

Few treatment studies and even fewer primary prevention studies have demonstrated successful reduction of child maltreatment. Successful preventive interventions have often been lengthy and expensive; shorter programs have been didactic and ineffective. The present investigation relied on a 7-level model of successful parenting to mount a time-limited, "selected" prevention effort with high-risk mothers. This program included modeling, role-playing, Socratic dialogue, home practice, and home visits. The study demonstrated effective intervention at every level of the model, including improvements in (a) parenting skills, (b) developmentally appropriate interventions, (c) developmentally appropriate beliefs, (d) negative affect, (e) acceptance of a responsible parent role, (f) acceptance of a nurturing parent role, and (g) self-efficacy. Directions for future research are considered.

Adaptation, Psychological↗
PubMed1999

Dental education and the European context.

Two hundred and sixteen additional dentists enter the Register from Europe annually [corrected]. Dental educational standards vary widely across Europe. Convergence is best promoted through exchanges (SOCRATES) and voluntary school visitations (DENTED). UK standards are set by the GDC and maintained by the schools. Consequently no school should be closed in response to current immigration levels by European dentists.

Clinical Competence↗
PubMed1999

A brief measure for the assessment of coping self-efficacy among alcohol and other drug users.

AIMS: To develop a reliable and valid brief measure of coping self-efficacy for substance users to serve the needs of clinicians and researchers who desire a global measure of a client's confidence across high-risk situations. The eight-item global measure of self-efficacy was derived from the Drug-Taking Confidence Questionnaire (DTCQ), a 50-item self-report measure of situation-specific coping self-efficacy applicable to alcohol and other drug users. DESIGN: The questionnaire was administered by trained staff to clients at intake to treatment. Items were selected using stepwise regression. Reliability and construct validity were assessed using alpha and correlation coefficients. SETTING: An addiction treatment facility in Toronto, Ontario. PARTICIPANTS: Seven hundred and thirteen English-speaking adults presenting for treatment with an alcohol or other drug problem. The sample was comprised of alcohol (344), cocaine (253), heroin (53), cannabis (43), other drug (20) users. MEASUREMENTS: The DTCQ: perceived difficulty quitting, motivation to quit and confidence in quitting; depression score (SCL-90-R); and motivation scores (SOCRATES-revised). FINDINGS: An eight-item version (DTCQ-8) accounted for 95% of the variance in the total DTCQ-50 scores and correlated 0.97 with the total DTCQ-50 score. Reliability and validity for the DTCQ-8 as a global indicator of coping self-efficacy was confirmed. CONCLUSIONS: Clinically, the DTCQ-8 is useful for the assessment and monitoring of confidence levels during treatment. The DTCQ-8 is a promising research tool for inclusion in outcome evaluation batteries that require a brief, reliable and valid measure of coping self-efficacy.

Adaptation, Psychological↗
PubMed2001

Back to the drawing board? A review of applications of the transtheoretical model to substance use.

The transtheoretical model (TTM) is still enormously popular with practitioners, clinicians and many researchers in the addictions field. However, in a recent years a number of commentators have criticized aspects of the model and the research based on it. This paper extends a recent critique of the TTM as applied to smoking cessation to include applications of the model to cessation or reduction of alcohol or drug use. The first section discusses measures of the central construct of stages of change and notes a number of serious problems. Staging algorithms are based on arbitrary time periods and some are logically flawed. In the case of multi-dimensional questionnaires (the URICA, the SOCRATES and the RCQ), the pattern of correlations among the subscales shows that they are not measuring discrete stages of change. The one study to date that has compared the two different methods found low concordance, which is probably due to incompatible stage definitions. In the second section of the paper, the evidence base for the TTM is reviewed. The review is organized by the four research designs that have been used to test predictions from stage models: cross-sectional comparisons of people in different stages; examination of stage sequences; longitudinal prediction of stage transitions; and experimental studies of matched and mismatched interventions. It concludes that current evidence for the model as applied to substance use is meagre and inconsistent. Researchers are urged to develop better stage models.

Cross-Sectional Studies↗