William H. O'Brien

A meta-analysis of the effect of hormone replacement therapy upon depressed mood.

This meta-analysis had two objectives: (a) to aggregate data from studies that used hormone replacement therapy (HRT) and a quantitative measure of depressed mood in order to examine the effectiveness of HRT upon menopausal depressed mood; and (b) to review the methodologies of this literature base. The overall effect size for HRT was 0.68. This indicated that the average treatment patient had lower levels of depressed mood than 76% of the control patients. Analyses of specific hormone treatments suggested that (a) estrogen significantly reduced depressed mood (ES = 0.69); (b) progesterone alone, and in combination with estrogen, was associated with smaller reductions in depressed mood (ES = 0.39, ES = 0.45, respectively); and (c) androgen alone and in combination with estrogen was associated with greater reductions in depressed mood (ES = 1.37; ES = 0.90, respectively). In summary, HRT appeared to be effective in reducing depressed mood among menopausal women. The methodological review indicated that most studies used adequate sample sizes, controlled research designs, random assignment, double-blind treatment manipulations, and valid and reliable measures of depression. Limitations in the interpretation of these results are discussed and recommendations for improved methodology are provided.

Functional analysis in behavior therapy

Abstract The functional analysis occupies a central role in behavioral construct systems and in behavior therapy. However, examination of the literature suggests that it is a conceptually amorphous term with multiple definitions. Such imprecision has resulted in inconsistency and restricted applications in clinical case conceptualizations and clinical decision-making. In order to clarify the nature of the functional analysis, this paper examines its epistemological bases and important dimensions of functional relationships. A definition of functional analysis is proposed that integrates the important characteristics of functional relationships with the tenets of behavioral construct systems. This definition can accommodate complex causal models which more accurately depict the behavioral interrelationships presented by most clients. Methods for deriving the functional analysis are then examined. A review of the literature suggests that pretreatment functional analyses are infrequently conducted. The construction of functional analytic causal models is proposed as a method of systematizing and organizing the functional analysis and facilitating its clinical impact.

An Ecological Momentary Assessment of Relapse Crises in Dieting.

Much of the research on relapse crises in dieting has focused on isolated lapse events and relied heavily on retrospective self-report data. The present study sought to overcome these limitations by using ecological momentary assessment (EMA) techniques to examine situations of dietary temptation and lapse with a sample of obese, formerly sedentary, postmenopausal women (N = 37) during the final week of a weight-loss intervention. Mood was associated with reports of dietary lapse. Abstinence-violation effects were more strongly associated with dietary lapses than temptations. Finally, coping responses distinguished dietary temptations from lapses. Education on the factors associated with relapse crises in dieting may be imperative for weight loss success and maintenance.

Ecological momentary assessment of temptation and lapse in dieting.

Although some research attention has been given to the factors associated with temptation and lapse in dieting, the majority of research has focused on individuals in weight loss clinical trials and relied heavily on retrospective self-report data. The present study sought to overcome these limitations by using ecological momentary assessment (EMA) techniques to examine situations of dietary temptation, lapse, and minimal dietary consequence with a sample of overweight dieters (N=30) attempting to lose weight on their own. Results support and extend previous research findings on dietary temptation and lapse. In general, results indicate that recent consumptive activity, location, mood state, type of activity, and abstinence violation effects were related to moments of temptation and/or lapse. Education on the factors associated with dietary temptation and lapse and strategies for addressing these factors is imperative for both dieters in formal programs and those attempting to lose or maintain weight on their own.

The early identification of poor treatment outcome in a women's weight loss program.

Research examining factors associated with program attrition or failure to lose weight during active treatment has yielded mixed findings. The goal of the current investigation was to confirm and extend prior research on the predictors and correlates of attrition and failure to lose weight during treatment. This investigation examined whether baseline characteristics, early weight loss, attendance, weight-related quality of life, confidence and difficulties with eating and exercise, and diet-related thoughts and feelings during the final week of treatment were associated with percentage change in body weight. Forty-four, obese, sedentary, postmenopausal women were recruited to participate in a 24-session weight loss intervention. Poor treatment outcome (i.e., percentage change in body weight) was significantly associated with several baseline characteristics including higher body mass index (BMI), greater fat and lower carbohydrate consumption, poor body image, and greater expectations for program success. Poor treatment outcome was also significantly associated with poor program attendance, unsatisfactory early weight loss, unsatisfactory improvements in weight-related quality of life, and lower self-control and self-confidence. By the end of active treatment, women with poor treatment outcome evidenced significantly higher levels of guilt and feelings of failure. The need for early identification and intervention with participants at risk for treatment failure is discussed.

Psychosocial functioning and physical symptoms in heart failure patients: A within-individual approach

OBJECTIVE Heart failure (HF) markedly diminishes an individuals quality of life. However, little is known about how psychosocial functioning is related to heart failure physical symptom expression (e.g., chest pain or heaviness, shortness of breath) on a day-to-day basis. METHODS Fifty-eight HF patients completed daily diaries that evaluated mood, social support, coping, and physical symptoms for 2 weeks. RESULTS After being prewhitened for serial dependencies, the data were entered into regression analyses to determine the concurrent and lagged relationships among them. Significant concurrent relationships were obtained between physical symptoms and depression, social conflict, positive and negative mood, and symptom-focused coping. Furthermore, negative mood and distraction coping predicted greater physical symptoms the next day, while action/acceptance coping predicted fewer physical symptoms the next day. CONCLUSION Our data provide evidence for an association between daily psychosocial functioning and HF physical symptoms. Implications for research and clinical work with HF patients are discussed.

Appraisal and Coping Responses to Pain and Stress in Migraine Headache Sufferers

The purpose of this study was to investigate how migraine headache sufferers and headache-free controls differ in their appraisal and coping responses to a cognitive (mental arithmetic) and a physical (cold pressor) laboratory stressor. Fifty-two women (26 migraine headache and 26 controls) completed the study. Results indicated that migraine sufferers rated the cold pressor task as significantly more painful compared to headache-free participants. Migraine headache sufferers also reported more wishful thinking and self-criticism in managing the mental arithmetic stressor. In addition, migraine participants reported the use of more social withdrawal and catastrophizing in managing stress and pain outside of the laboratory.

Meta-analysis of cognitive-behavioral treatment studies for bulimia

A meta-analysis was performed to systematically assess the effect of cognitive-behavioral treatments for bulimia. To protect against past criticisms of meta-analyses, this study focused on well-defined hypotheses with clearly articulated conceptual foundations. Twenty-six studies of the cognitive-behavioral treatment of bulimia were selected through computer searches. Effect sizes were calculated for changes in behavioral outcome measures (25 independent hypothesis tests) and cognitive-attitudinal outcome measures (17 independent hypothesis tests). Additionally, two effect sizes were generated for within and between group comparisons. The analysis revealed an effect size of average r = 0.69 for behavioral outcome measures (average r = 0.64 for between group and average r = 0.74 for within group) and average r = 0.67 for cognitive-attitudinal outcome measures (average r = 0.64 for between group and average r = 0.69 for within group). Follow-up effect sizes were less favorable; however, the diversity of time spans and outcome measures used to calculate follow-up effect sizes limit their utility. Overall, results suggest that the use of a cognitive-behavioral therapy will result in favorable treatment outcomes and implications for future research are discussed.

Barriers to physical activity in an on-site corporate fitness center.

Many corporations provide employees the option of participating in on-site fitness centers, but utilization rates are low. Perceived barriers to physical activity have been established as important correlates of physical activity, and recent research indicates that barriers may vary across settings. Work-site fitness centers may present unique barriers to participation, but there are currently no standardized measures that assess such barriers. Eighty-eight employees of a midwestern corporation completed a survey designed to identify and evaluate the extent to which barriers influence participation in an on-site corporate fitness center. Regression analyses revealed that external environmental barriers (e.g., inadequate exercise facilities) significantly accounted for not joining the fitness center, and for decreased duration of visits to the facility among members. Internal barriers (e.g., feeling embarrassed to exercise around coworkers) significantly accounted for frequency of fitness center visits among members. This corporate specific measure may lead to more effective interventions aimed to increase use of on-site corporate fitness centers.

Differences in heartbeat awareness among males with higher and lower levels of systolic blood pressure

Recent empirical findings related to the baroreceptor hypothesis indicate that elevated heart rate, pulse pressure, and blood pressure may dampen exteroception and interoception. We thus predicted that persons with elevated systolic blood pressure would be less able to accurately perceive their heartbeats and profit from feedback training. This study examined the plausibility of this hypothesis by exposing 57 male students (11 with elevated SBP levels and 46 with normotensive SBP levels) to the Whitehead heartbeat perception task with, and without, feedback training. Results indicated that participants with elevated SBP levels were more able to accurately perceive their heartbeats prior to, and after, feedback training. Participants with elevated SBP levels also showed a significant increase in heartbeat perception accuracy when they were provided with feedback training while participants with normotensive blood pressure levels did not show a significant response to feedback training. These findings are interpreted in terms of the ballistic perception model of cardiac awareness.