Jennifer Nicolai

Patterns of alcohol expectancies and alcohol use across age and gender

AIMS To investigate the relationship between alcohol expectancies and alcohol use in a community sample as a function of age and gender. METHODS The study is based on a national probability sample of 6467 German adults. Respondents were grouped into five age groups ranging from 18 to 59 years. A brief version of the Comprehensive Alcohol Expectancy Questionnaire was used to assess alcohol expectancies. Alcohol use was assessed by the number of drinking days during the past month and the number of drinks on an average drinking day. RESULTS Prior to conducting group comparisons, measurement invariance across age and gender was established. Latent mean level comparisons showed that the endorsement of both positive and negative expectancies almost linearly decreased with increasing age. However, this decrease was not reflected in alcohol consumption patterns. Structural analysis of the expectancy factors and drinking variables showed that the predictive power of expectancies varied by age and gender. Particularly, expectancies related to social assertiveness and sexual enhancement were strong predictors only in younger, but not in older respondents. Conversely, expectancies related to tension reduction and impairment were the most important predictors of drinking in respondents older than 30 years, but not in younger age groups. Additionally, the onset and course of age-related changes in expectancies was moderated by gender. CONCLUSIONS The present study demonstrates substantial age-related changes in the relationship between alcohol expectancies and alcohol use. Moreover, the profile of alcohol expectancies appears to be more important than their absolute strength.

The Comprehensive Alcohol Expectancy Questionnaire: Confirmatory factor analysis, scale refinement, and further validation

The Comprehensive Alcohol Expectancy Questionnaire (CAEQ; Demmel & Hagen, 2003a, 2003b) is a self-report measure designed to assess an individual’s alcohol expectancies. In this study, we examined the CAEQ in a student sample (N= 932) and in a clinical sample of alcohol-dependent inpatients (N= 744). The Five-factor structure was confirmed by means of confirmatory factor analysis. Convergent validity of the revised CAEQ was supported by showing significant relationships to quantity and frequency of drinking. The results of this study suggest that the revised CAEQ appears to be a psychometrically sound tool for the assessment of alcohol expectancies among both students and alcohol-dependent inpatients.

Effects of mode of presentation on ratings of empathic communication in medical interviews

OBJECTIVE To test the impact of nonverbal behaviour on the assessment of a clinicians level of empathic communication. METHODS One hundred volunteers were asked to assess a clinicians level of empathic communication using the Rating Scales for the Assessment of Empathic Communication in Medical Interviews (REM). Participants were randomly assigned to three groups differing with regard to the level of nonverbal information made available to them. Participants either watched a simulated medical interview, listened to an audio-only version of this interview, or read a transcribed version of the interview. RESULTS Compared to watching a video and listening to an audiotape, respectively, reading a transcribed version of the interview produced lower empathy ratings and interrater reliabilities. CONCLUSIONS The findings suggest that assessments of a clinicians level of empathic communication may differ according to the level of nonverbal information made available to the raters. PRACTICE IMPLICATIONS Focusing on the verbal level of communication alone ignores the fact that empathy can be expressed through nonverbal means. Hence, nonverbal channels need to be taken into account in addition to the verbal channel when conducting research on empathic communication in health care.

Interprofessional education about patient decision support in specialty care.

Specialty care involves services provided by health professionals who focus on treating diseases affecting one body system. In contrast to primary care – aimed at providing continuous, comprehensive care – specialty care often involves intermittent episodes of care focused around specific medical conditions. In addition, it typically includes multiple providers who have unique areas of expertise that are important in supporting patients’ care. Interprofessional care involves multiple professionals from different disciplines collaborating to provide an integrated approach to patient care. For patients to experience continuity of care across interprofessional providers, providers need to communicate and maintain a shared sense of responsibility to their patients. In this article, we describe challenges inherent in providing interprofessional patient decision support in specialty care. We propose ways for providers to engage in interprofessional decision support and discuss promising approaches to teaching an interprofessional decision support to specialty care providers. Additional evaluation and empirical research are required before further recommendations can be made about education for interprofessional decision support in specialty care.

Effects of mood state on impulsivity in pathological buying.

Pathological buying is characterized by irrepressible buying behaviour and its negative consequences. A possible mechanism contributing to its development and maintenance is that buying episodes act as a maladaptive strategy to cope with negative emotions. Accordingly, pathological buying has been repeatedly associated with impulsivity, in particular with the tendency to experience strong reactions under negative affect. Relying on an experimental mood induction procedure, the present study tested in a sample of 100 individuals (a) whether individuals with pathological buying symptoms respond more impulsively in the Go/No-Go Task (as a measure of the behavioural inhibition aspect of impulsivity) and (b) whether this association is more pronounced in a negative mood. While controlling for comorbidities, the results show that pathological buying is associated with faster responses and a larger number of commission errors. Moreover, a significant interaction indicated that the association between pathological buying and performance the Go/No-Go Task was stronger in the negative mood condition. The present study thus shows that pathological buying is associated with deficits in the behavioural inhibition component of impulsivity. These deficits are most pronounced when mood is negative; in turn, this provides an explanation for the occurrence of excessive buying episodes following negative affect.

A test of expectancy-value theory in predicting alcohol consumption*

Abstract Background: Research on alcohol-related outcome expectancies has primarily focused on the likelihood of the anticipated effects, while comparatively little attention has been paid to their subjective evaluation. However, according to expectancy-value theory, the expectation that alcohol use will produce certain consequences and the evaluation of those consequences jointly and interactively determine an individuals decision to consume alcohol. Previous research on this issue was hampered by multiple regression strategies that are plagued by measurement error and low statistical power. Method: To overcome this limitation, we investigated expectancy-value interactions in predicting drinking variables by drawing on latent variable methodology using the five expectancy-value dimensions from the Comprehensive Alcohol Expectancy Questionnaire. Expectancy-value models were tested in a sample of college students (N = 1053) and a sample of alcohol-dependent inpatients (N = 699). Results: Significant expectancy-value interactions emerged concerning social assertiveness among students as well as for aggression and tension reduction among alcohol-dependent inpatients. The relationship between expectancy and drinking was strongest for pronounced (either positive or negative) valuations of the effect. Effect sizes were small, however. Conclusions: The results are in partial agreement with basic premises of expectancy-value theory. However, this study also identifies limits to the universal validity of expectancy-value theory, given that prediction of alcohol use depends on the effect domains, alcohol outcome measures, and study populations.

Pathological buying symptoms are associated with distortions in judging elapsed time

Background and aims Pathological buying (PB) is often assumed to be related to deficits in impulse control. Distortions in judging elapsed time are one component of behavioral impulsivity. This study was set out to examine the hypothesis that PB propensity is associated with distorted time perception, such that time is perceived to pass more slowly. Methods The study is based on a convenience sample of 78 adults. Symptom severity of PB and related problems/disorders (substance use, borderline, depression, mania, and obsessive–compulsive disorder) as well as four dimensions of trait impulsivity were assessed. A time-production task was employed that required participants to produce prespecified time intervals ranging from 1 to 60 s. Results PB propensity was associated with the belief that time elapses more slowly, even when controlling for symptoms of related disorders and general trait impulsivity. Neither trait impulsivity nor symptoms of related disorders were predictive of distortions in judging elapsed time. Discussion and conclusion These results suggest that PB propensity is related with non-specific, general deficits in judging elapsed time as a specific component of behavioral impulsivity.

To change or not to change – That is the question: A qualitative study of lifestyle changes following acute myocardial infarction

Objective The purpose of this study was to investigate key factors related to lifestyle changes following acute myocardial infarction (AMI) by eliciting survivors’ subjective needs for, attitudes towards and experiences with behaviour changes in their everyday life to improve future interventions promoting lifestyle changes. Methods Semi-structured interviews were conducted with 21 individuals who had recently experienced an AMI. The interviews were audio-recorded and transcribed verbatim. The data were analysed using qualitative content analysis. Results The data analysis revealed that lifestyle changes following AMI are influenced by a combination of individual (physical and psychological) and social factors that can be grouped into facilitators and barriers. The interviews indicated the need for more personalised information regarding the causes and risk factors of illness, the benefits of lifestyle changes and the importance of including significant others in lifestyle advice and education and of individualising support. Discussion Lifestyle change is a continuous process that is not completed within a few months after a cardiac event. Considering the identified themes when developing interventions to promote lifestyle changes following AMI may enhance the effectiveness and sustainability of such interventions.

Dissociating Pathological Buying From Obsessive-Compulsive Symptoms Using Delay Discounting

Pathological buying (PB) has been associated with elevated impulsivity in personality inventories, yet limited research has considered components of behavioral impulsivity. This study examined the relationship between discounting of delayed rewards, symptoms of PB, comorbid disorders (including obsessive-compulsive disorder, OCD), and trait impulsivity. One hundred three participants completed two delay discounting tasks (DDT). In addition to the traditional DDT, a loan variant assessing the preference to receive a certain amount of money immediately when a fixed amount has to be returned after a certain delay was included in this study. Regression analysis revealed that PB symptoms predicted steeper discounting functions in both variants of the DDT over and above the remaining symptom measures and trait impulsivity. In contrast, symptoms of OCD were associated with less delay discounting. With regard to delay discounting, PB seems to be more similar to behavioral addictions than to OCD.