UT Southwestern School of Health Professions
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Welcome to the UT Southwestern School of Health Profession’s electronic theses and dissertations (ETD) collection. (Note: The school was previously named the UT Southwestern School of Allied Health Sciences.)
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Item Relationship of Internalizing Behavior Problems to Intelligence and Executive Functioning in Children(2005-12-20) McClintock, Shawn Michael; Silver, Cheryl H.The current theme of research regarding children has focused greatly on emotional intelligence, Attention Deficit Hyperactivity Disorder (ADHD), and other problems involving emotional disorders. While there is a great amount of research devoted to these topics, there is a lack of consensus on the effects these emotional disorders have on the areas of intelligence and executive functioning in children. This study examined the relationship between internalizing behavior problems (depression, anxiety, and social withdrawal) and intelligence and executive functioning in children. Archival data, from 75 children between the ages of 6 and 14, were used. The sample consisted of children with internalizing behavior problems and children without internalizing or externalizing behavior problems, which was classified using the Child Behavior Checklist (CBCL). Each child was evaluated using the Wechsler Intelligence scale for Children-Third Edition (WISC-III), Children's Executive Function Scale (CEFS), and the Category Test. Results indicated that children with internalizing behavior problems performed significantly worse in domains of global executive function, problem solving, and initiative. No significant differences were found between the control and internalizing groups in the domain of intellectual functioning. This study supports the premise that executive function and intelligence are separate domains and should both be assessed in children with internalizing behavior disorders.Item Comparing Distribution-Based and Anchor-Based Minimal Clinically Important Difference Values for Temporomandibular Disorder(2011-10-03) Ingram, Megan Elizabeth; Gatchel, Robert J.; Haggard, Robbie; Chiu, Chung-YiThe current study is a continuation of studies by Gatchel and colleagues. Data were collected from 101 patients at several community dental clinics. Based on the patients' initial evaluations, they were randomly assigned to one of three treatment groups: Low Risk/Non-intervention Group; High Risk/Biobehavioral Group; or High Risk/Self-Care Group. This study attempted to better understand and objectively quantify meaningful symptom relief by determining the minimal clinically important difference (MCID) for temporomandibular joint disorder (TMD). Despite limitations and controversy with determining the most appropriate method, this information will play an important role in determining treatment effectiveness for not only TMD, but for other pain conditions as well. The most commonly referenced methods for determining meaningful change are the distribution- and anchor-based approaches. Distribution-based minimal detectable change (MDC) values were calculated using the formula 95% CI=1.96 x Square Root(2) x SEM, while the anchor-based approach minimal clinically important change (MCID) values were calculated using a Receiver Operating Curve (ROC). Both mean particle size and broadness of distribution served as two separate functional anchors, and normal range and .5 SD as two separate cutoff methods. Despite some variability, the MCID values were relatively consistent with the MDC values regardless of method, anchor, or cutoff for both the Physical Component Scale (PCS) and Mental Component Scale (MCS) of the SF-36. The Characteristic Pain Inventory and Graded Chronic Pain Scale showed a narrow range of variation within the MCID values; however, the MCID values calculated were significantly higher than the MDC values reported for the same measures. Findings indicated that the PCS component of the SF-36 provided stronger evidence of clinically meaningful change. The PCS resulted in asymptotic values closer to .1 (at the 90% confidence interval) with areas under the curve that better fit the model compared to the other subjective measures (considered fair at .701 when using the normal range and .740 when using .5SD for the Biobehavioral Group). Additionally, broadness of distribution resulted in more clinically meaningful changes as a result of better metric values when comparing the biobehavioral versus the self-care groups.Item Two Efficacy Studies for Acute TMJ Related Headaches and Chronic Headaches(2011-10-03) Hinds, Christopher Worth; Gatchel, Robert J.; Haggard, Robbie; Chiu, Chung-YiThis project focused on two efficacy studies. The aim of the first study conducted by Dr. Robert Gatchel at University of Texas at Arlington was to evaluate the efficacy of the Biobehavioral, Self-care, and Non-Intervention treatment groups on the presence and distress of the headache symptom related to acute temporomandibular joint disorder. The study consists of a cohort of 283 patients with acute TMD. Participants are being referred to UT Southwestern Medical Center in Dallas, Texas through the community dental clinics in the Dallas/Ft. Worth area. Questionnaires were administered to patients before and after treatment. At the time of data collection 283 participants were enrolled in the study. 238 participants (84%) of 283 met eligibility requirements and were placed in one of the three treatment groups.91 participants endorsed having regular headaches that are either new or different from headaches you had prior to the onset of your illness. A Pearson Chi-Square (χ2) found a significant difference in the presence of headaches before treatment (χ2 = 11.082, p =.004). No significant difference was found in the presence of headaches after treatment (χ2 = .335, p =.846). Non-Parametric analysis found a significant difference of improvement (.021) in the Biobehavioral group post-treatment. A significant difference of improvement (.023) was also found in the Self-care group post-treatment. Non- Parametric analysis found a significant improvement of distress of headache in each treatment group. This study shows a significant prevalence of 38% headaches related to TMD. It also shows that Biobehavioral and Self-care treatments significantly reduce headache presence. The study also finds a psychological effect of “attending the project” in decreasing levels of distress relating to headaches. The second study aimed to measure the effectiveness of a dental technique pioneered by Dr. Neeley DDS. Patients were referred through his private dental clinic in Dallas, TX. Qualitative analysis was used through a case study of 6 patients of an original 12. The data from the second study indicated that this treatment is very efficacious. All 6 participants showed a reduction in headache symptoms and all reported satisfaction with their treatment over a year later.Item The Prevalence of Temporomandibular Disorder in African Americans(2011-12-09) Doyle, Nicole J.; Gatchel, Robert J.; Chiu, Chung-Yi; Haggard, RobbieThis pilot study collected a convenience sample of adult residents of the Dallas, Texas metropolitan area to estimate the prevalence of temporomandibular disorder (TMD) in African Americans. Additionally, the study also collected the same data on Caucasians for comparisons against the African American numbers on all measures. At the conception of this study, there existed no prior studies focusing primarily on prevalence of TMD in African Americans. The study administered a survey of acute jaw pain symptoms to a convenience sample of 274 participants 18 years and older, 129 African Americans, 116 Caucasians and 29 of other races. The survey assessed TMD symptoms using 19 questions derived from the Research Diagnostic Criteria for TMD. The overall prevalence of TMD for total sample of 274 was 22.3%, with a higher prevalence of TMD in women (25.3%) than in men (16%). The prevalence of TMD among African Americans was 22% with a higher prevalence among females (24.4%) than males (15.6%). Among Caucasians, the prevalence of TMD was 22.5%, with a higher prevalence among females (23.7%) than males (20%). Caucasians reported greater rates of tinnitus, low back pain (p<.05), clenching and grinding (p<.1), while African Americans reported greater rates of teeth problems (p<.1). For all-participants, African American and Caucasian samples, discriminant analysis showed the ability of the symptoms listed on the survey to classify correctly the participants as having TMD or as not having TMD approached 100%. Among the top predictors of TMD for African Americans were earache and sounds around ears, while among top predictors for Caucasians were a diagnosis of TMD and joint locking. Distinct symptom clusters found within the overall sample as well as a 2-symptom cluster within both African American and Caucasian samples, yielded highly significant differences. In treatment seeking for TMD symptoms, both African Americans and Caucasians with private insurance types sought treatment at the same rates (60%). TMD rates for this sample were notably higher than found in other national studies (about 4-8%). However, where definitions of and measurement instruments for TMD differ among prevalence studies, it appears that prevalence rates tend to differ.Item Efficacy of an Early Biopsychosocial Intervention for Patients with Acute Temporomandibular Disorder-Related Pain: a Six- to Ten-Year Follow Up Study(2011-12-09) Fraley, Sarah Elizabeth; Gatchel, Robert J.; Stowell, Anna W.; Chiu, Chung-YiA long-term follow up study was conducted to further evaluate the efficacy of an early biopsychosocial intervention for patients with acute high risk (HR) temporomandibular disorder (TMD). Subjects from Gatchel and colleagues’ one-year outcome study (Gatchel, Stowell, Wildenstein, Riggs, & Ellis, 2006), and two- to six-year follow up study (Gatchel, Potter, Hinds, & Ingram, 2011) were contacted to assess pain and psychosocial measures six to ten years post intake. An early intervention (EI) group had received cognitive behavioral skills training and biofeedback, while a nonintervention (NI) group had received no intervention. EI group subjects demonstrated significant improvement as well as maintenance of gains in several psychosocial domains, including coping skills and reduction in depression scores relative to NI group subjects. EI group subjects also showed a decreasing trend in jaw pain-related healthcare visits relative to NI group subjects, providing further evidence for reduced costs associated with early interventions. The present study supports the findings of the earlier one-year outcome study and two- to six-year follow up study, indicating that an early biopsychosocial intervention is beneficial for patients with acute TMD. In utilizing this approach to treat patients in the acute stage of TMD, these patients are less likely to develop chronic TMD, and to be impacted long-term by the physical, emotional, and financial aspects of TMD.Item Maternal Depressive Symptoms and Its Relationship to Outcomes of Adolescents with Type 1 Diabetes in a Diverse Sample of Caucasian and Latino Youth(2012-05-18) Godbey, Elida Isabel; Wiebe, Deborah J.; Chiu, Chung-Yi; Reed, GabrielaPURPOSE/BACKGROUND: Maternal depression can have deleterious effects on adolescents' psychosocial adjustment and management of type1 diabetes. These associations have been primarily studied among Caucasian middle-income families. Ethnic minority status and economic disadvantage may alter the experience of maternal depressive symptoms and their association with adolescent diabetes management. The purpose of this study was to determine if mothers' depressive symptoms are similarly associated with adolescent diabetes outcomes in Caucasian and Latino/a youth, and whether associations occur independent of socioeconomic factors. METHODS: Participants were Caucasian and Latina mothers and their adolescents with type I diabetes (N=118 dyads; 48% Latino; 54% female; 10 to 15 years old; illness duration > 1 year; 25% on insulin pump). Mothers completed surveys assessing depressive symptoms, household income and parental education. Adolescents reported treatment adherence and depressive symptoms. Metabolic control was determined from HbA1c from medical records. Socio-demographic information was collected through a combination of maternal report and census tract data. RESULTS: Although Latino participants had lower socioeconomic status (SES) than Caucasian participants, there were no ethnic group differences in terms of parental marital status, adolescent age, adolescent gender, illness duration, or insulin pump status. Latina mothers reported significantly more depressive symptoms than Caucasian mothers t (112) = 2.48, p = .015, and these differences were independent of lower SES among Latina mothers. Hierarchical regression analyses revealed maternal reports of depressive symptoms were associated with higher adolescent depression t(108) = 1.98, p = .05, but this association was moderated by both a two-way interaction with adolescent age, t(105) = 2.13, p = .036, and a three-way interaction with age and ethnicity, t(104) = -2.05, p = .043. Among older Latino adolescents, maternal depressive symptoms were positively associated with adolescent report of depression; this association was not found among older Caucasian participants or among younger participants. There were no significant associations between maternal depressive symptoms and adolescent adherence. All associations remained independent of SES indicators, which were generally unrelated to adolescent outcomes. CONCLUSION: Maternal depressive symptoms may undermine the psychosocial adjustment of adolescents with diabetes, but appears to have complex associations with diabetes management across ethnic groups. The finding that Latino youth did not experience heightened depression despite the risks of their mother's elevated depressive symptoms and lower SES is potentially quite important. If replicable, further research should explore potential protective factors that may be contributing to adolescent diabetes outcomes in Latino families.Item The Effect of Rapamycin Paired with Traumatic Memory Activation on Cognitive Performance in Veterans Diagnosed with PTSD(2012-05-18) Anderson, Elizabeth Hallen; Surís, Alina; North, Carol S.; Powell, Craig M.BACKGROUND: Many individuals with posttraumatic stress disorder (PTSD) experience cognitive impairment in addition to the characteristic psychological symptoms. Animal studies have shown that rapamycin, a protein synthesis inhibitor that targets the protein kinase mTOR, can prevent the reconsolidation of a reactivated fear memory, thereby reducing its emotional strength at a neurochemical level. The aim of the current study was to determine if pairing rapamycin with traumatic memory reactivation in male veterans with combat-related PTSD would lead to an improvement in cognitive performance, based on scores from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at baseline and 1-month follow-up. SUBJECTS: A sample of 54 male veterans with combat-related PTSD receiving healthcare at a large southwestern VA medical center participated in the study. METHODS: In a double-blind, placebo-controlled study, male veterans with combatrelated PTSD were administered either a single dose of rapamycin or placebo, followed by a script-driven memory reactivation task. Measures included the RBANS, Clinician Administered PTSD Scale (CAPS), and the Quick Inventory of Depressive Symptomatology (QIDS). RESULTS: A repeated measures ANOVA was conducted to assess the impact of two different interventions (rapamycin, placebo) on participants' scores on the RBANS, across two time periods (baseline, one-month follow-up). The main effect comparing the two type of interventions revealed no significant differences in the effectiveness of the two interventions in the entire sample; F (1,48) = .01, p = .921, partial eta squared < .001. When the sample was limited to participants who demonstrated a clinically significant reduction (≥ 20 points) in their CAPS score, a repeated measures ANOVA revealed a significant interaction between time and treatment intervention; Wilks Lambda = .44, F (1, 13) = 16.74, p = .001, partial eta squared = .563. Pairwise comparisons showed a significant improvement between baseline and one-month follow-up on the RBANS for participants in the placebo group, mean difference = 10.00, p = .002. DISCUSSION: Based on these results, a single rapamycin treatment does not appear to be detrimental or beneficial to cognitive performance. Furthermore, a clinically significant reduction in PTSD symptoms due to rapamycin is not associated with an improvement in cognitive performance.Item The Utilization of GPS Technology in Tracking Homeless Adults: A Pilot Study(2012-05-18) Wohlford, Sarah Elizabeth; North, Carol S.; Black, Melissa; Dean, DenisThe purposes of the present study were to examine the feasibility of using GPS technology in a difficult-to-follow homeless population and to develop GPS tracking methods that researchers can utilize in future studies. Twenty individuals were recruited from a homeless day center. Each carried a GPS unit to record their movements for approximately 24 hours. Participants completed interviews consisting of demographic questions, a pre-tracking survey, and a post-tracking survey about planned and reported travels respectively and also submitted urine specimens for substance use testing. GPS data were downloaded from the tracking device and exported into ArcMap 10 and SAS 9.3 for analysis. Concerted efforts were made to achieve successful deployment with the first eight participants, necessitating refinement of the research procedures. Thereafter, 81% success was attained in collecting adequate deployment data. Travel distances varied (.05-36 miles), mostly taken on foot and by city bus. No GPS units were lost during deployment, although one was water-damaged in a shower. Challenges encountered in the study included battery problems (power drainage, theft), signal loss, lengthy initial calibrations (up to 15 minutes), inaccurate recordings due to drift of satellite anchors to positions, and difficulties re-engaging with participants post deployment. The study demonstrated the feasibility of using GPS technology to track movements of a difficult-to-track population. This work has clarified the need to integrate GPS and self-report data to maximize the precision of geospatial data. The success of this pilot study suggests novel potentials for GPS technology to improve service access and identify geospatial barriers to care.Item Expectancy, Adherence, and Depression as Predictors of Therapeutic Outcome as Measured by PTSD Symptoms in Veterans with MST(2012-05-18) Azimipour, Solaleh; Surís, Alina; North, Carol S.; Thoman, Lisa V.BACKGROUND: The aim of this study was to explore the association between treatment outcome expectancy, adherence to treatment, and depressive symptoms on symptom reduction in the treatment of PTSD in Veterans. SUBJECTS: Participants were female and male veterans from a large Southwestern Veterans Administration Healthcare System. A total of 129 participants were randomized to receive cognitive processing therapy (CPT) or present-centered therapy (PCT). Participants completed baseline assessments prior to starting 12 sessions of therapy. METHODS: Data from the Clinician Administered PTSD Scale (CAPS), the PTSD Checklist (PCL), Beck Depression Inventory II (BDI-II), the 16-Item Quick Inventory of Depression Symptomatology (QIDS), Expectancy of Therapeutic Outcome (ETO), homework assigned to the participants, and the number of therapy sessions completed were used in the analysis of the hypotheses. Spearman correlations and multiple regressions were used to analyze the data RESULTS: Both number of sessions attended in the CPT group and number of sessions attended in both groups combined were significantly associated with an improvement in depression symptoms as measured by change in the QIDS score (CPT ? = .31, both ? = .29). Attendance to sessions in the CPT group was not associated with change in the PCL score. The total average minutes spent on homework in the CPT group was significantly associated with worsening of PTSD symptoms as measured by an increase in the CAPS score (? = -.51) in one model and by an increase in the PCL score (? = -.30) in a separate model. The percent of homework assignments completed in the CPT group was significantly associated with improvement in PTSD symptoms as measured by a decrease in the CAPS score (? = .32). A significant relationship was found between outcome expectancy and the number of sessions attended in the PCT group (? = .42;.39). The relationship between baseline depression symptom level as measured by the QIDS and the total average number of minutes spent on homework fell short of significance in the CPT group, p = .07. There were no significant associations between baseline depression and treatment outcome expectancy. DISCUSSION: Greater outcome expectancy was associated with increased attendance to sessions in the PCT group, but not in the CPT group. However, greater expectancy did not predict adherence to homework and the amount of time spend doing homework. As expected, in the CPT group as well as both groups together, greater attendance to sessions was associated with an improvement in symptoms of depression. Greater adherence to homework assignments was associated with an improvement in PTSD symptoms. Contrary to predictions however, greater time spent doing the homework was associated with a worsening of PTSD symptoms and greater depression at baseline was associated with greater time spent completing homework. Furthermore, baseline depression did not predict treatment outcome expectancy, and expectancy did not predict PTSD and depression symptoms at treatment completion. IMPLICATIONS: A greater expectation of benefit from treatment could be an indication that an individual is motivated to change. It is possible that expectations of treatment, attendance to therapy sessions, and completing homework in between sessions, are the key to benefiting from therapy.Item Influences on Mental Health Service Utilization for Vietnamese Young Adults(2012-08-15) Phan, Hang Tu; Stewart, Sunita M.; Lee, Simon Craddock; Chiu, Chung-YiBACKGROUND: Vietnamese-Americans underutilize mental health services. Several factors have been proposed to influence rates of service utilization within this population, including cultural identification and families' acceptance of such services. Most measures of cultural identification are lengthy and burdensome. Furthermore, studies examining the link between parental attitudes towards mental health services and their children's attitudes have only included children who were under the age of 18 - therefore unable to legally seek their own services. This study was designed to address these gaps by developing and testing brief scales of identification with Vietnamese and American culture, and obtaining information about the influence of parents' attitudes on older adolescents and young adults in this cultural group where a strong family orientation persists through the lifespan. A third aim of the study was to examine the role of the participants' acceptance of mental health services both as a predictor for utilization of such services, and as a mediator between other predictors and utilization. SUBJECTS: The participants in the study included a total of 87 Vietnamese-American young adults between the ages of 18 to 30 years old. Participants were recruited from the Texas Exes Asian Alumni Network (TEAAN) in Austin, Texas and from the Mother of Perpetual Faith Catholic Church's youth group. Recruitment also occurred through a method called the "snowball effect," where those involved in the study were asked to help recruit additional participants. METHOD: Surveys were completed on-line. Participants reported their mental health service utilization in the past 12 months. They also were administered measures of potential predictors: cultural identification scales, the participants' distress level, perceived stigma towards mental health services, perceived parental acceptance of mental health services, and their own (personal) acceptance of mental health services. RESULTS: The psychometric properties of the brief cultural identification scales were examined; the scales have good validity, but slightly low reliability. None of the proposed factors were found to be significant predictors of formal mental health service utilization, but items assessing distress level were found to correlate with service utilization at a trend level. The only factor found to predict personal acceptance was perceived parental acceptance of these services. Because personal acceptance was not found to be a predictor of mental health service use, it could not serve as a mediating variable between the other factors and service utilization. DISCUSSION: Before the originally developed cultural identity scales can be used for research, further development of the scales will be necessary. A limitation of this study is that there were very few participants who reported formal mental health service utilization, reducing the power to determine prediction to this variable. In this sample, only distress was found to be even a marginal predictor of mental health service use, suggesting that the low rates of mental health service utilization found in these Vietnamese young adults may in fact be due to actual low levels of psychological distress. The fact that parental acceptance significantly predicted personal acceptance of mental health services among participants supports the idea that parental attitudes towards mental health services may have been adopted by their children, even after they were independent enough to seek their own services. Future research and clinical implications are discussed.Item The Impact of Specialized Family Camps on Quality of Life and Hope in Families Who Are Coping with Pediatric Cancer(2012-08-15) Cook, Ellen Claire; Wetherington, Crista E.; Germann, Julie; Chiu, Chung-Yi; Leavey, PatrickBACKGROUND: Over the past several decades, specialized summer camps for children with cancer have been shown to have various positive results in those who attend. Family camps have become increasingly popular over the past few years, but the efficacy of family camps for specialized populations has not been well established through research. In addition, few studies have addressed the benefits of the camp experience over time, especially in regard to its impact on quality of life. The aim of this study was to learn whether or not the family camp experience increases the quality of life of families with a child with cancer, and whether or not these changes are maintained after the camp experience ends. In addition, this study examined the impact of camp on levels of hope, and analyzed how hope and social support contribute to the quality of life of those who attend camp. SUBJECTS: A total of 66 families participated in this study. Participants include parents, cancer patients or survivors, and siblings. Thirty-nine families who attended a specialized weekend camp participated in the study, and a control sample of 27 families who did not attend camp was recruited as well. METHOD: Questionnaire data was collected at three time points: pre-camp, post-camp, and a three-month follow up. Measures included a demographic questionnaire, age appropriate versions of the PedsQLTM 4.0 Generic Core Scales, the PedsQLTM 2.0 PedsQLTM 2.0 Family Impact Module, the Hope Scale (Adult and Child versions), the Young Children’s Hope Scale, and a brief follow-up questionnaire. RESULTS: Quality of life did not significantly increase in the camp group in the overall family unit. However, quality of life was shown to be significantly higher in the camp group than the control group at the beginning and end of camp. Siblings demonstrated a significant increase in quality of life when examined separately from the family unit. No significant changes in hope or differences in hope between groups were observed. DISCUSSION: Though this study did not demonstrate the efficacy of family camp as predicted, it did show that individual family members are impacted by camp in different ways. Camp has been show to benefit siblings in particular, which is indicated by improvement in quality of life, hope, and social support in this population. This study also shows that different results may be found using different measures of the same variables.Item Demoralization as a Factor in a Vocational Rehabilitation Population Using the Demoralization Scale (RCd) of the MMPI-2-RF(2012-08-15) Wishart, Alfred B.; Casenave, Gerald W.; Turner, Mary; Whitfill, TravisBACKGROUND: Demoralization has come to be recognized as an essential element of psychological health. Its prevalence and role as a factor in discreet populations has been studied such as with medical and psychiatric populations though not in the field of Vocational Rehabilitation (VR). In most of this research, the Demoralization Scale (RCd) of the MMPI-2-RF was not used. This study looks at the prevalence of demoralization in a VR population using the RCd. SUBJECTS: The subjects for this study (N = 54) were evaluated for vocational potential by the University Rehabilitation Services (URS) in the Department of Rehabilitation Counseling at the Southwestern School of Health Professions. They were referred by the Department of Assistive and Rehabilitative Services (DARS) of Texas except for one client who was self-referred. METHOD: Basic demographic data (age, ethnicity, IQ, and gender), along with the scores of the MMPI-2-RF scales were gathered. Comparisons were made between the study population and normative populations for the prevalence and degree of demoralization. Further, two correlation analyses were run. The first was for intercorrelations between the RCd and the other Restructured Clinical Scales (RCS) of the MMPI-2-RF and the Clinical Scales (CS) of the MMPI-2. The second, was for intercorrelations between the RCd and other, selected scales of the MMPI-2. RESULTS: The prevalence of demoralization in the study population was higher than in the general population. There were data to suggest that the degree of demoralization in the study population was greater than in the general population, though further research is needed to confirm this. The data on the intercorrelations between the RCd, the RCS, and the CS replicated earlier research; variations are discussed. Unexpected correlations between the RCd and selected scales for the study population were noted and discussed. DISCUSSION: The higher prevalence of demoralization in the study population than in the normative population bears particular significance for VR. Research has shown that demoralization is a key factor in psychological health and in VR. The degree of demoralization in the study population is high and further research is needed to determine if there is are greater degrees of demoralization in a VP population as compare to a normative population. For correlations of the RCd to other scales, there were several unexpected differences in the intercorrelations between the RCd, the RCS, the CS. These data suggest that the study population may have a higher prevalence of somatic symptoms and antisocial traits, and a lower prevalence of cynicism. The strong correlation between the RCd and the WRK scale suggests that demoralization may be a key factor in VR. The absence of recent data on the prevalence of demoralization in the general population diminished the generalizability of the findings. However, the results of this study revealed gaps in the literature that provide direction for future investigations.Item Cross-Cultural Comparison of Parental Perspectives of Health-Related Quality of Life in Children with Cochlear Implants(2012-11-28) Kumar, Roshini Ruth; Silver, Cheryl H.; Warner-Czyz, Andrea D.; Tobey, Emily A.BACKGROUND: Assessing health-related quality of life (HRQoL) is a useful way to quantify benefits that cochlear implants (CI) provide children with hearing loss. Since children often are too young or lack communication skills to convey their HRQoL, parents serve as a reliable proxy. This study examines parent report of HRQoL (categorized in eight domains) and demographic variables in children with CI. Lastly, this study compares parent HRQoL ratings in the United States (US) to parent ratings in the Netherlands, Finland and the United Kingdom (UK). SUBJECTS: Parents of 33 children with CIs participated in the US component of this study. METHOD: An analysis of variance was used to measure differences among HRQoL domains. Correlations between HRQoL and demographic variables, and correlations among HRQoL domains were assessed using Spearman and point bi-serial correlations. Cross-cultural differences in HRQoL domain scores were computed using one sample t-tests. RESULTS: In this US sample, education and effects of CI domains were rated least positively. Cross-culturally, US parents rated HRQoL more positively than parents in the Netherlands, generally less positively than parents in Finland and aligned most closely with parents in the UK. DISCUSSION: Limited access to CI-related accommodations and varying parent expectations likely explain the differences in low ratings of education and effects of implantation in the US, as well as the differences seen cross-culturally. Providing useful CI accommodations at school and preparing parents for realistic outcomes could greatly benefit children with CI and their families.Item University of Texas Southwestern Medical Center Group Therapy Outcomes: Social Skills Training for Adults with Mental Illness(2012-12-06) Russo, Amanda; Chiu, Chung-Yi; Casenave, Gerald W.; Rose, LindseyBACKGROUND: Group therapy is an effective method of treating people with various mental illnesses. Social skills training is often used in a group therapy setting to improve the social functioning of people with mental illness, many of whom have social skills deficits. Currently, there is very little literature on how social skills training reduces symptomology, most of which is limited to children or adolescents and people with autism spectrum disorders. The current study looks to determine what, if any, effect social skills training has on alleviating depression and anxiety symptoms in a mixed mental illness sample. SUBJECTS: 23 subjects were recruited from the University Rehabilitative Services to take part in the study. There were 11 males and 12 females divided into two treatment groups named Connections (CG) and Personal and Social Adjustment Treatment (PSATG). METHOD: A one-way paired samples t-test was used to determine improvement between pre and post BDI-II and BAI scores. RESULTS: BDI-II scores were significantly lowered, indicating improvement in depression symptoms. BAI scores were not statistically significant. DISCUSSION: Social skills training does alleviate depression symptoms in an adult mixed mental illness sample. Future studies need to focus on improving anxiety symptoms as well.Item A Proposed Battery Used to Monitor Treatment Outcomes in Individuals with Multiple Sclerosis: A Case Study(2013-05-17) Riggs, Amanda Lynn; Gatchel, Robert J.; Chiu, Chung-Yi; Haggard, RobbieBACKGROUND: Multiple Sclerosis (MS) is a chronic disease of the central nervous system. As of now, there is no cure for MS, but different forms of treatment have been studied to ameliorate both physical and psychosocial symptoms. Numerous measures have been used within the MS population to monitor symptoms before, during, and after treatment. The aim of this present study was to ensure the usefulness of a battery of outcome measures that will assess MS-related symptoms before and after standard treatment. Another aim of the study was to assess treatment outcomes and determine the current success of each individualized treatment plan. SUBJECTS: All participants had a confirmed diagnosis of MS, were able to read and write in English, were 18 years of age and older, and able to walk, even briefly, with or without an assistive device. Participants were recruited through The University of Texas Southwestern Medical Center, Multiple Sclerosis Clinic. METHOD: Ten qualified MS patients were given a Six-minute walk test, two cognitive tests, and nine psychosocial measures as a baseline assessment. After six to eight weeks of Standard care, all participants were asked to return in order to complete all the measures again. It was hypothesized that the proposed battery of measures would prove to be useful in monitoring treatment outcomes in patients with MS. It was also hypothesized that individualized treatment would prove to be beneficial to each participant over the course of the study. RESULTS: This study did not provide any evidence that the individualized treatment was beneficial. Moreover, it did not provide any evidence that this particular battery was sensitive enough to truly monitor treatment outcomes. There was only one significant difference found between initial and follow-up assessment. The sum of ranks for the BORG was 0.00 (Z = -2.00, p = .046, r = -0.89) when comparing breathlessness scores. This indicates that individuals that returned for follow-up assessment experienced less breathlessness at follow-up assessment before and after the Six-minute Walk Test than before and after the Six-minute Walk test upon initial assessment. DISCUSSION: The period between assessments may not have been long enough to identify any changes in treatment or treatment outcomes. Due to the unpredictable nature of MS, it may be important for providers to assess individuals using a comprehensive, biopsychosocial battery on a case-by-case basis rather than a generalized pre-established time frame.Item The Role of Cognitive Processing Therapy in Treating Post Traumatic Cognitions and Symptoms Associated with Military Sexual Trauma(2013-05-17) Vera, Kristie Marie; Surís, Alina; Thoman, Lisa V.; Smith, JuliaBACKGROUND: Military Sexual Trauma (MST) is psychological trauma that results from sexual assault while in the military service. One common anxiety disorder following MST is Posttraumatic Stress Disorder (PTSD). Negative cognitions about the event, the self, and the world are hypothesized to be associated with the onset and persistence of PTSD. SUBJECTS: The participant data for this study was taken from a larger study that examined the effectiveness of Cognitive Processing Therapy (CPT) for treating Military Sexual Trauma-related (MST) Post Traumatic Stress Disorder (PTSD). The sample consisted of 76 participants, 63 female veterans and 13 male veterans. METHOD: Participants were randomized into two groups who received either CPT or PCT. The participants were assessed at baseline using the CAPS, PCL, BDI-II and PTCI. They participated in 12 therapy sessions and were assessed using the same measures at post-treatment, 2, 4, and 6-month follow-ups. RESULTS: The current study provides preliminary evidence that the number of negative cognitions is decreased over time in both CPT and PCT interventions for veterans with PTSD related to MST. Also, that the decrease in number of negative cognitions is positively related with decreased PTSD and depressions symptoms. DISCUSSION: These findings are important because they support the idea that negative cognitions contribute to PTSD and depression symptoms, while also providing evidence that CPT and PCT are effective in reducing negative cognitions.Item Examining the Relationship Between Impulsive Personalities and Neural Functioning in Cocaine-Addicted Participants(2013-05-17) Jester, Bryan Elliott; Adinoff, Bryon H.; North, Carol S.; Spence, JeffreyBACKGROUND: Those who suffer from addiction are unable to discontinue use despite serious consequences affecting their social, professional, and family lives. Individuals who suffer from the disorder often alienate themselves from loved ones and lose their jobs. Addiction involves continuing a behavior despite severe negative consequences. Numerous studies have identified a relationship between impulsivity and the development of substance abuse. This study examines the relationship of impulsive personality facets and neural functioning associated with inhibition. SUBJECTS: The study sample included 24 healthy control participants and 56 cocaine-addicted participants. Participants ranged in age from 25 to 54 years old with a mean age of 43.27 (±SD 7.84). The group was comprised of 68 male and 12 female participants, 28.7% self identified as Caucasian, 66.3% African American, 3.8% Hispanic, and 1.3% Asian/Other. Healthy controls and cocaine-addicted participants were similar in age and race but differed in gender (p= .02). The control group had 17 males and 7 females while the cocaine-addicted group had 51 males and 5 females. METHODS: Demographic information was gathered for all participants. Each participant also completed a Neuroticism Extroversion and Openness (NEO) personality measure and Temperament and Character Inventory (TCI), Structured Clinical Interview for DSM-IV (SCID), Wechsler Test of Adult Reading (WTAR). They then performed the stop signal task (SST) during functional magnetic resonance imaging (fMRI) to gather data on neural activation during Stop-Success (SS) and Stop-Failure (SF). fMRI data was analyzed using FSL imaging software. All statistics were run with SPSS software. Functional ROIs were identified and analyzed in fMRI Expert Analysis Tool query (FEATqueary) to gather data on each participantÕs change in blood oxygen level dependent (BOLD) activation during Stop-Success (SS) and Stop-Failure (SF). Impulsive personality facets were then used to identify relationships between BOLD activations of the ROIs. RESULTS: Between group comparisons found significant differences in mean scores on all of the impulsive personality facets except for Exploratory Excitability and Persistence from the TCI, and Excitement Seeking from the NEO. Neuroimaging results are similar to other studies utilizing the SST finding changes in activation of the middle frontal gyrus, superior frontal gyrus, cingulate gyrus, medial frontal gyrus, insula, caudate and supramarginal gyrus during Stop-Failure; and superior parietal lobule, middle frontal gyrus, precuneus, supramarginal gyrus, inferior temporal gyrus, and middle occipital gyrus during Stop-Success. However, no differences in BOLD activation between groups were observed. Numerous relationships were identified between the personality facets and BOLD activation of the regions of interest (ROIs). To further elucidate this relationship between neural functioning and personality a principal component analysis (PCA) was conducted on all eleven personality facets. The PCA allowed for the identification of an impulse control personality component and an impulse drive personality component. A significant interaction with the impulse drive and the left posterior hippocampus was identified. DISCUSSION: This study allowed for the examination of how impulsive personality facets relate to, or interact with, neural functioning during a task designed to measure inhibition. Despite failing to find a difference in activation of the ROIs between cocaine-addicted participants and healthy controls, the study successfully identified the cocaine-addicted group to have a significantly more impulsive personality than healthy controls. It also identified numerous relationships between the personality facets and neural functioning. This gives credence to the idea that neural functioning and personalities are associated in some way. Reverse relationships were observed between the groups in the relationships between the Impulse Drive personality component and SF activation of the hippocampus; and the TCI facet of Purposefulness and SS activation of the right thalmus. These reverse relationships may signify a difference between the groups that may either predispose the cocaine-addicted participants to developing substance abuse, or it may be a neuro-functional change that has resulted due to prolonged exposure to cocaine.Item Self-Management of Physical Activity in African Americans and Hispanics with Multiple Sclerosis: Mixed Methods(2013-05-17) Griffith, Desiree Nicole; Chiu, Chung-Yi; Rose, Lindsey; Frierson, GeoritaBACKGROUND: People with multiple sclerosis (MS) are prone to inactivity due to mobility impairments, which too often leads to obesity and other secondary conditions (e.g. depression, diabetes). Minorities with MS have health disparities when compared to Caucasians with MS, but the current health behavior theories were developed and validated mainly among the Caucasian population. There is a paucity of research considering multicultural perspectives for minorities with MS. The present study used the Health Action Process Approach (HAPA) as a theoretically driven framework to study how people with MS, specifically African Americans (AF) and Hispanics, self-manage their physical activity (PA). SUBJECTS: Eighteen AF (4 males, 14 females) with MS were recruited, ages 27-61 years old (M = 44.72, SD = 8.89). Three Hispanics (3 females) with MS were recruited, ages 27-54 years old (M = 38.33, SD = 14.01). They were all diagnosed with MS on average about 8 years prior (M = 7.83, SD = 5.58) and the majority of the participants (n = 18, 86%) lived in the Dallas-Forth Worth area. METHODS: Recruiting flyers were posted in the Multiple Sclerosis Clinic at UT Southwestern Medical Center, neurology clinics, churches in the community, and the National Multiple Sclerosis Society website. This study used a mixed methods research design. Qualitative data, used to gather minorities’ perspectives of their self-promotion of PA, was collected via focus groups and phone interviews; this data was transcribed verbatim and coded. For quantitative data, each participant filled out several HAPA surveys to assess severity of symptoms, self-efficacy, coping and planning, and PA engagement. RESULTS: An independent samples t-test was conducted to examine whether there was a significant difference between AF and Caucasians in self-evaluation of HAPA constructs, using an archived data of 170 Caucasians with MS as a norm for following comparisons. All measured HAPA constructs for PA were not significantly different between AF and Caucasians with MS. Interestingly, AF with MS had stronger intention to eat healthily (when comparing 18 Caucasians and 18 AF, t = -3.29, df = 34, p = 0.002; when comparing a norm database of 170 Caucasians and 18 AF, t = -2.31, df = 186, p = 0.02). However, Caucasians with MS had higher recovery self-efficacy for nutrition than the counterpart (comparing 170 Caucasians and 18 AF, t = 2.63, df = 186, p = 0.009). Qualitative analyses of transcriptions from six focus groups produced significant themes of self-motivated regulation of health promotion for minorities with MS. Significantly, modified item content on some HAPA-based measures is required to make the model more conducive to AF. For example, the study found that PA has been redefined for minorities with MS, self-efficacy is based on successful daily functional PA, it is not necessary to make a PA schedule because the course of MS is unpredictable, and self-defined PA goals vary according to daily MS course. DISCUSSION: Although many HAPA constructs were shared amongst AF, Hispanics, and Caucasians, this study discovered many new themes that were related to how minorities with MS approach PA. AF with MS redefined exercise as being any body movement costing physical energy. For AF, the fear of losing life roles and daily functioning was motivation to persevere and do any PA given the opportunity. In contrast to many studies on AF, this study showed AF with MS do not need social support from family or friends to do PA because they view it as self-responsibility and they have learned to be independent. For Hispanics, it appeared as though collective family thoughts regarding exercise were more influential on the intention to engage in PA. AF and Hispanics with MS agreed healthy eating habits had equal importance to PA for people with relatively severe MS status. Being AF commonly led to late treatment of MS among the focus group participants.Item Use of Cognitive Screening and the Influence of Psychosocial Variables in Identification of Cognitive Impairment in MS(2013-05-17) Ritter, Ashley Reyes; Lacritz, Laura H.; Hynan, Linda S.; Cullum, C. MunroBACKGROUND: The purpose of this project is to examine the potential of abbreviated cognitive screening to identify patients with clinically significant cognitive dysfunction. A secondary goal is to examine relationships between cognitive functioning and psychosocial factors of disease. SUBJECTS: The study includes 94 subjects with a Demyelinating disease [M age = 45.04 (11.08); M education = 15.40 (2.13)] who were referred to the University of Texas Southwestern Medical Multiple Sclerosis Clinical Center and Multiple Sclerosis Program and signed informed consent for a larger study on cognition in multiple sclerosis and demyelinating disease. METHOD: Subjects completed a screening battery (JoL, 9HPT, PASAT, SDMT-Oral, and T25FW) at visit one and a larger cognitive assessment within 4 weeks of visit one, which was used to divide subjects into impaired and non-impaired groups. Linear regression was used to assess which tests on the screening battery predicted impairment on the longer battery. Associations between psychosocial factors of depression, fatigue, and sleepiness were examined in relation to cognitive performance. The relationship between depression and objective versus subjective cognitive performance was also examined. RESULTS: The PASAT (p = .001) was the only measure in the screening battery that predicted group membership, with correct classification of 76% of subjects using a cut score of T ² 38. Depression (QIDS-SR) was significantly correlated with self-reported cognitive dysfunction (MSNQ) (r = .57; p = <.001) but only modestly associated with the four measures on the screening battery (r = -.17 to .25). Those who endorsed depressive symptoms performed lower on JoL(p = .003), PASAT (p = .015) and SDMT (p = .023). Level of fatigue was associated with cognitive performance, as significant mean differences were found on all screening battery measures in high versus low fatigue groups. There was no impact of sleepiness on cognition. DISCUSSION: Complex attention was the most sensitive measure for predicting cognitive impairment on a more comprehensive battery and may be a good screening tool in identifying who might benefit from more detailed testing. Higher levels of depression and fatigue significantly impacted test performance and highlight important areas for screening and treatment, while daytime sleepiness had no effect.Item Relationship Between Exercise and Cognitive Functioning in Breast Cancer Survivors Following Chemotherapy(2013-05-17) Antony, Merlyn; Kendall, Jeffrey; Cullum, C. Munro; Chiu, Chung-YiBACKGROUND: A growing body of research suggests that individuals who undergo chemotherapy for treatment of cancer experience adverse changes in cognitive functioning as a side effect of treatment. While there is not yet a known remedy for such effects, exercise has shown to improve cognitive functioning in individuals within other clinical populations. Therefore, the purpose of this current study is to examine whether any relationships exist between self-reported post-chemotherapy exercise and cognitive functioning. SUBJECTS: The sample consisted of sixty female breast cancer survivors between the ages of 38-71. All participants had been diagnosed with stage I, II, or III breast cancer and had completed chemotherapy between three months to two years prior to their study visit. METHOD: Participants completed a self-report measure of post-chemotherapy exercise behavior and were administered a battery of neurocognitive tests to measure cognitive functioning. Subjects were categorized into one of three exercise groups based on their total exercise score (LSI): sedentary (LSI < 14), moderately active (LSI = 14-23), or active (LSI > 24). Mean scores on cognitive tests between exercise groups were compared to determine whether significant differences existed between groups both before and after controlling for IQ. Additionally, a hierarchical multiple regression was performed to determine how much of the variance in cognitive test scores could be explained by the following predictors: age, education, IQ, anxiety, depression, and exercise. RESULTS: Only three test scores (CVLT, Digit Span Backward, and Digit Symbol Coding) showed significant differences between exercise groups. Before controlling for IQ, CVLT (F=7.40, p=.001) and Digit Span Backward (F=3.01, p=.057) displayed significant differences between groups. After controlling for IQ, CVLT (F=4.19, p=.012), Digit Span Backward (F=5.98, p=.004), and Coding (F=3.05, p=.055) displayed significant differences. Predictors explained a small portion of the variance in cognitive test scores. DISCUSSION: Only three out of seven cognitive test scores demonstrated differences between exercise groups. Even among those tests that showed differences, higher levels of exercise were not consistently associated with better performance. In some cases, a moderate level of exercise seemed to have an optimal effect with regard to cognitive performance, suggesting the possibility of a dosing effect of exercise. Overall these findings suggest that a possible relationship may exist, but additional research is warranted