S. Olsen

Adherence to Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnoea sufferers: A theoretical approach to treatment adherence and intervention

Obstructive Sleep Apnoea (OSA) is a common sleep disorder associated with significant health, quality of life and psychosocial problems. The aims of this review are to investigate the contribution of psychological constructs and theory to the assessment and treatment of OSA. Adherence to CPAP treatment remains a primary concern for improving treatment outcomes for OSA. Modifiable, psychological constructs of self-efficacy, coping, social support, treatment satisfaction and self-reported daytime sleepiness improve the prediction of CPAP adherence. These predictors are particularly robust in the context of a theoretical model. Social Cognition Theory (SCT) and Health Belief Model (HBM) are emerging as promising psychological models for understanding patient acceptance and adherence to CPAP treatment. An overview of psychologically informed interventions for CPAP use is presented. Education-based interventions have promise, but the strongest and robust findings are emerging from theory-driven interventions. Specifically, Cognitive-Behaviourally informed interventions and Motivational Interventions demonstrate consistent and large effect sizes in improving CPAP adherence rates.

Cognitive-Behavioral Group Therapy for Heterogeneous Anxiety and Mood Disorders in a Psychiatric Hospital Outpatient Clinic

Recent literature has shown that group cognitive-behavioral therapy (CBT) is effective for individuals with heterogeneous anxiety disorders. However, these studies have used a narrow range of outcome measures, and have not included global measures such as quality of life. In addition, heterogeneous mood disorders have not been well researched. The aim of this study was to replicate and extend on previous studies by assessing the effectiveness of group CBT treatment programs designed for use with heterogeneous anxiety or depressive disorders. Global outcome measures of quality of life and social functioning were assessed in addition to outcome measures of anxiety and mood symptoms. There were 173 patients who completed either group CBT for anxiety disorders or for depressive disorders. Symptom measures and quality of life measures were used to determine treatment effectiveness. Results demonstrated that the treatments were effective in reducing overall symptom severity and improving quality of life. Treatment gains were maintained to 12 month follow-up. However, the degree of change was considerably lower than that found in comparable trials with diagnostically homogenous samples. Overall, group CBT for heterogeneous diagnostic populations was effective but requires further investigation and refinement.

The rapid screen of concussion: An evaluation of the non-word repetition test for use in mTBI research

Primary objectives: (1) To investigate the Nonword Repetition test (NWR) as an index of sub-vocal rehearsal deficits after mild traumatic brain injury (mTBI); (2) to assess the reliability, validity and sensitivity of the NWR; and (3) to compare the NWR to more sensitive tests of verbal memory. Research design: An independent groups design. Methods and procedures: Study 1 administered the NWR to 46 mTBI and 61 uninjured controls with the Rapid Screen of Concussion (RSC). Study 2 compared mTBI, orthopaedic and uninjured participants on the NWR and the Hopkins Verbal Learning Test (HVLT-R). Main outcomes and results: The NWR did not improve the diagnostic accuracy of the RSC. However, it is reliable and indexes sub-vocal rehearsal speed. These findings provide evidence that although the current form of the NWR lacks sensitivity to the impact of mTBI, the development of a more sensitive test of sub-vocal rehearsal deficits following mTBI is warranted.

Motivation and Outcome Expectancies Predict Adherence to CPAP before Experience with CPAP

Introduction: Continuous Positive Airway Pressure (CPAP) can be an effective therapy for Obstructive Sleep Apnoea (OSA), but adherence is often poor. Biomedical indices explain little of the variance in CPAP use. This study tested a motivational model of adherence using psychological constructs. Methods: 77 consecutive patients (61% male, mean age = 55.25, mean RDI = 38.36) newly diagnosed with OSA who were NAIVE to CPAP, completed questionnaires assessing; outcome expectancy with treatment, self-efficacy, functional outcomes of sleepiness, apnoea beliefs and perceived risk of negative health outcomes. Physiological data from standard clinical diagnostic sleep study was obtained. Objective CPAP adherence was assessed at 3 months post-treatment initiation. Results: Patients used CPAP an average 4.57 hours per night. Physiological indices explained 10.4% (p > 0.05) of the variance in CPAP adherence, while risk and self-efficacy uniquely explained an additional 6.3% of the variance (p > 0.05). Outcome expectancies and functional outcomes of sleep added in the final model explained an additional significant unique proportion of the variance (15.3%), and in combination with the above steps explained a total of 32% of the variance in CPAP adherence (R = 0.566, p < 0.01). Conclusion: Results supported a hierarchical model of adherence. Functional outcomes of sleepiness and outcome expectancies before CPAP is first tried uniquely predicted adherence suggesting that psychological indices, rather than disease severity and physiological indices, are most important in patients’ adherence to effective therapy. Significant inter-relationships between variables at each hierarchical step suggest the need for more sophisticated statistical modelling in explaining motivation to use CPAP.

Psychological versus physiological correlates of sleep apnoea treatment adherence

Continuous Positive Airway Pressure (CPAP) is an effective therapy for Obstructive Sleep Apnoea (OSA), but adherence is poor. This study tested a motivational model of adherence at 3 months post-treatment initiation. 77 consecutive patients (61% male) newly diagnosed with OSA completed questionnaires assessing; outcome expectancy with treatment, self-efficacy, functional outcomes of sleepiness, and perceived risk of negative health outcomes. Physiological data from a standard clinical diagnostic sleep study were obtained. Average objective adherence to CPAP was 4.57 hours per night. Physiological indices correlated with adherence in the opposite direction to that expected. Fewer oxygen dips and fewer arousals before treatment were associated with greater adherence at 3 months. In a hierarchical regression, these physiological variables did not explain significant portions of the variance in CPAP adherence (10.4%, p>.05), whilst treatment outcome expectancies and functional outcomes of sleep explained a unique proportion of the variance (15.3%, p<.05), and in combination with physiological variables explained 32% of the total variance in CPAP adherence (p<.01). The implications of the physiological findings in terms of hypoxic events, cognition and subsequent adherence will be discussed. An intervention for targeting functional outcomes of sleepiness and outcome expectancies to increase patients’ adherence to treatment will be outlined.

Motivation and outcome expectancies predict treatment adherence in patients with Obstructive Sleep Apnoea (OSA)

Very few Australian residential care facilities have access to psychological services. Clearly, very few Australian psychologists provide services to residential care facilities. Various factors underlie this situation. The tensions in the dual funding of health care between Commonwealth and the States and chronic under funding of aged care services are major issues, but factors within the profession are also relevant. The limited exposure to older adults and issues that are common in clinical training programs is one factor. The limited number of placements available for students to gain practical experience with older adults is also something of concern if more psychologists are to have positive experiences in working with older adults. This forum will explore strategies for increasing placement opportunities for students to work in residential care facilities and increasing incentives for psychological services in residential care. Another issue for discussion will be methods for increasing the number of supervisors for such work and for ensuring positive outcomes.This study explored associations between HRT and psychological well-being, state affect,health status, and episodic memory functioning in healthy postmenopausal women. Seventy participants aged 49-77 years (Mean age = 58.93) and 13.96 mean years of education took part in the study. Of those, 35 had been on HRT for a minimum of 18 months, whereas 35 reported never having used HRT, or had discontinued use at least two years prior to the study. Mean depression and anxiety scores were in the “minimal” range for both groups, however, HRTusers’ depression scores were significantly lower. Anxiety levels also tended to be lower in this group. State affect was assessed pre- and postmemory testing. HRT-users reported significantly higher levels of Energetic Arousal and Hedonic Tone, and significantly lower Tense Arousal and Anger/Frustration pre-memory testing. Posttesting, Hedonic Tone remained significantly higher in the HRT group. Mean percent word recalled on the episodic memory tasks was higher for HRT-users compared to non-users, but not significantly different. Result from the regression analyses showed that education and physical health, but not HRT, significantly predicted memory performance. Results from this study offer some evidence for a more diffuse effect of HRT, which was independent of age and educationA significant increase in the number of older Australians is predicted over the next decade with corresponding increases in the amount of disorders potentially necessitating intervention from a psychologist. A survey was carried out with the aim of identifying key factors in a psychologist’s decision to work with older clients. Results from 1,498 practising clinicians Australia-wide identified training, as opposed to positive personal contact independent of training, as being the main influence on specialising in working with older clients. Critical to training was having had positive clinical experiences with older clients via a placement and having undergone training external to formal psychology education as indicated by independent group comparisons and logical regression analysis. Interest and confidence in working with older clients were attitudinal variables also identified as being influential. In order to examine directionality of these findings, over 300 graduate psychology program students were surveyed. Survey results were also important in gaining accurate information as to the number of psychologists practising in this specialty, their evaluations of training programs in terms of preparing them to work with older client groups and related demographic variables such as age and years of experience. Recommendations regarding future training in gero-psychology are put forward.