David C. Howell

When Mom or Dad Has Cancer: II. Coping, Cognitive Appraisals, and Psychological Distress in Children of Cancer Patients

Cognitive appraisals and coping were examined in children, adolescents, and young adults (N = 134) faced with the diagnosis of cancer in a parent. All 3 age groups perceived low personal control and high external control over their parents illness and used relatively little problem-focused coping. Adolescents and young adults reported more emotion-focused coping and dual-focused coping (both problem- and emotion-focused in intent) than did preadolescent children. Stage and prognosis of parents cancer were related to appraisals of greater seriousness and stressfulness, and to more avoidance; however, only appraisals of stress were related to symptoms of anxiety-depression. Emotion-focused coping was related to greater avoidance and to higher symptoms of anxiety-depression; coping and control beliefs did not interact in their association with anxiety-depression symptoms.

Daily and major life events: A test of an integrative model of psychosocial stress

The hypothesis that negative daily events mediate the relationship between major negative events and psychological symptomatology was tested using a three-wave, three-variable panel design. Measures of major and daily life events and psychological symptomatology were administered to 58 older adolescents at three time points during the transition from high school to college. The results indicated that the pathways from major life events to daily events and from daily events to psychological symptomatology were significant at each of the time points, but that the direct pathways from major events to psychological symptomatology were not significant at any time point. Thus, the hypothesis was fully supported. The findings are discussed in light of their implications for an integrative theory of the process by which major and daily events have an effect on psychological symptomatology.

Predictors of cancer progression in young adult men and women: avoidance, intrusive thoughts, and psychological symptoms.

Psychological symptoms, avoidance, and intrusive thoughts were examined prospectively as predictors of cancer progression over a period of 1 year. Sixty-six male and female cancer patients who differed in their diagnoses and initial disease-severity ratings participated. Measures of psychological factors, disease severity, and type of treatment were obtained near time of diagnosis and disease status (no cancer, continued or recurrent cancer, or deceased) 1 year later. Cross-sectional analyses near the time of diagnosis showed that initial psychological variables were intercorrelated with one another but unrelated to initial disease prognosis. Longitudinal findings revealed that, after controlling for initial disease parameters and age, avoidance predicted disease status 1 year later; however, neither psychological symptoms nor intrusive thoughts and emotions accounted for additional variance in disease outcomes.

On comparing a single case with a control sample: an alternative perspective

Corballis [Corballis, M. C. (2009). Comparing a single case with a control sample: Refinements and extensions. Neuropsychologia] offers an interesting position paper on statistical inference in single-case studies. The following points arise: (1) Testing whether we can reject the null hypothesis that a patients score is an observation from the population of control scores can be a legitimate aim for single-case researchers, not just clinicians. (2) Counter to the claim made by Corballis [Corballis, M. C. (2009). Comparing a single case with a control sample: Refinements and extensions. Neuropsychologia], Crawford and Howells [Crawford, J. R., & Howell, D. C. (1998). Comparing an individuals test score against norms derived from small samples. The Clinical Neuropsychologist, 12, 482-486] method does test whether we can reject the above null hypothesis. (3) In all but the most unusual of circumstances Crawford and Howells method can also safely be used to test whether the mean of a notional patient population is lower than that of a control population, should neuropsychologists wish to construe the test in this way. (4) In contrast, the method proposed by Corballis is not legitimate for either of these purposes because it fails to allow for uncertainty over the control mean (as a result Type I errors will not be under control). (5) The use of a mixed ANOVA design to compare a case to controls (with or without the adjustment proposed by Corballis) is beset with problems but these can be overcome using alternative methods.

Life stress, psychological symptoms and weight reducing behavior in adolescent girls: A prospective analysis

Daily and major life stress, psychological symptoms, and dieting were measured in 143 adolescent girls ages 14–18 at the beginning and end of a 4-month prospective study. Two hypothetical relations among the variables were examined; (1) that weight reducing in adolescents is predicted by stress and psychological symptoms prospectively, versus (2) that stress and psychological symptoms are a consequence of increased weight-reducing efforts. Stress and symptoms were related to weight reducing in cross-sectional correlations. Multiple regressions and LISREL analyses showed that future levels of psychological stress, but not symptoms, were predicted by weight-reducing behavior when baseline scores were controlled. The hypothesis that negative psychological functioning predicts more dieting in the future was not supported. Besides potential physical health hazards of weight reducing during adolescence and its apparent status as a risk factor for eating disorders, this indicates that weight reducing also may have some negative psychological impact on the young dieter.

Testing for a deficit in single-case studies : Effects of departures from normality

In neuropsychological single-case research inferences concerning a patients cognitive status are often based on referring the patients test score to those obtained from a modestly sized control sample. Two methods of testing for a deficit (z and a method proposed by Crawford and Howell [Crawford, J. R. & Howell, D. C. (1998). Comparing an individuals test score against norms derived from small samples. The Clinical Neuropsychologist, 12, 482-486]) both assume the control distribution is normal but this assumption will often be violated in practice. Monte Carlo simulation was employed to study the effects of leptokurtosis and the combination of skew and leptokurtosis on the Type I error rates for these two methods. For Crawford and Howells method, leptokurtosis produced only a modest inflation of the Type I error rate when the control sample N was small-to-modest in size and error rates were lower than the specified rates at larger N. In contrast, the combination of leptokurtosis and skew produced marked inflation of error rates for small Ns. With a specified error rate of 5%, actual error rates as high as 14.31% and 9.96% were observed for z and Crawford and Howells method respectively. Potential solutions to the problem of non-normal data are evaluated.

Cognitive factors in adjustment to cancer: attributions of self-blame and perceptions of control.

We examined attributions of behavioral and characterological self-blame and perceptions of control over disease progression and recurrence as predictors of symptoms of psychological distress in a sample of adult men and women with cancer. Data were obtained near the time of diagnosis and at 4-month follow-up. Initial levels of behavioral and characterological self-blame were unrelated to concurrent psychological distress. Initial characterological self-blame as well as the interaction of characterological and behavioral self-blame was predictive of psychological distress 4 months later. Perceptions of control over cancer recurrence were unrelated to psychological distress near diagnosis or at follow-up, and control beliefs did not function as a mediator of self-blame. Initial levels of psychological distress predicted characterological but not behavioral self-blame at follow-up, suggesting a reciprocal relationship between characterological self-blame and distress.

Intra-individual measures of association in neuropsychology: Inferential methods for comparing a single case with a control or normative sample

Performance on some neuropsychological tests is best expressed as an intra-individual measure of association (such as a parametric or non-parametric correlation coefficient or the slope of a regression line). Examples of the use of intra-individual measures of association (IIMAs) include the quantification of performance on tests designed to assess temporal order memory or the accuracy of time estimation. The present paper presents methods for comparing a patients performance with a control or normative sample when performance is expressed as an IIMA. The methods test if there is a significant difference between a patients IIMA and those obtained from controls, yield an estimate of the abnormality of the patients IIMA, and provide confidence limits on the level of abnormality. The methods can be used with normative or control samples of any size and will therefore be of particular relevance to single-case researchers. A method for comparing the difference between a patients scores on two measures with the differences observed in controls is also described (one or both measures can be IIMAs). All the methods require only summary statistics (rather than the raw data from the normative or control sample); it is hoped that this feature will encourage the development of norms for tasks that use IIMAs to quantify performance. Worked examples of the statistical methods are provided using data from a clinical case and controls. A computer program (for PCs) that implements the methods is described and made available.

Intrusive thoughts and avoidance in breast cancer: Individual differences and association with psychological distress.

Abstract Eighty-five women with newly diagnosed breast cancer were classified on the basis of high and low levels of cancer-related intrusive thoughts and avoidance at diagnosis, and their psychological adjustment was studied prospectively at 3 and 6 months post diagnosis. Patients who initially reported high levels of both intrusive thoughts and avoidance and those who reported high levels of intrusive thoughts but low avoidance experienced the highest levels of anxiety and depression symptoms, and continued intrusive thoughts and avoidance. Patients who were high in avoidance but low in intrusive thoughts also experienced adjustment problems, including increased intrusive thoughts, when compared with patients who were low in both types of symptoms. The findings highlight the value of considering subgroup differences in patterns of intrusion and avoidance as predictors of subsequent psychological adjustment to breast cancer.

INFERENTIAL METHODS FOR COMPARING A SINGLE CASE WITH A CONTROL SAMPLE: MODIFIED t-TESTS VERSUS MYCROFT ET AL.'S (2002) MODIFIED ANOVA

Mycroft, Mitchell, and Kay (2002) have criticised existing inferential methods (e.g., Crawford & Howell, 1998) for comparing a single case with a control sample and propose that such comparisons be made using a modified ANOVA. It is argued that the assumptions made by Mycroft et al. are questionable and, even if they held, would not invalidate Crawford and Howells method. Crawford and Howells null hypothesis is that the patient is an observation from the control population whereas Mycroft et al.s null hypothesis is that the control population and a notional population of patients have a common mean. Even if one accepts Mycroft et al.s conceptualisation, their arguments only have force if (1) the variance of a notional population of patients was larger than that of the control population, and (2) patients with impaired performance were balanced exactly by patients whose performance had been enhanced relative to controls. Furthermore, the modified ANOVA would have the undesirable consequence of reducing statistical power unnecessarily and it requires users to provide some estimate of the variance of a hypothetical population.