L'exclusion sociale est considérée comme l'une des situations les plus douloureuses pour les êtres humains. Les travaux dans ce domaine montrent que même de brefs épisodes d’ostracisme (paradigme du Cyberball) ont des effets importants aux niveaux neurophysiologique, émotionnel et comportemental, l’impact de cet ostracisme au niveau cognitif néanmoins n'a pas reçu beaucoup d'attention. Des résultats récents mettent en évidence une influence négative de l'ostracisme sur les marqueurs électrophysiologiques du contrôle cognitif, il n'y a cependant à ce jour aucune preuve directe d’une réduction de contrôle cognitif sous l’effet d’une exclusion sociale. Dans nos travaux nous avons étudié l'impact de l'ostracisme (Cyberball) sur le contrôle cognitif avec la tâche standard de Simon couplée à des analyses distributionnelles des temps de réaction auprès de populations caractérisées ou non par des expériences chroniques d’ostracisme (i.e., des étudiants ordinaires dans l’Étude 1, des personnes illettrées dans l'Étude 2 et des chômeurs de longue durée dans l'Étude 3). Dans les trois études, de brefs épisodes d'exclusion sociale suffisent à dégrader le niveau de satisfaction exprimé par les participants à l’égard des besoins fondamentaux (appartenance sociale, existence significative, estime de soi, contrôle des événements). Ces effets, cependant, s’avèrent réduits dans les populations chroniquement frappées d'ostracisme, suggérant leur moindre sensibilité à l'exclusion sociale en jeu dans le Cyberball. Plus important encore, cet ostracisme provoque chez les participants non stigmatisés une diminution du contrôle cognitif (Étude 1), mise en évidence dans nos travaux par un effet Simon stable (plutôt que réduit) sur les temps de réaction les plus longs pourtant les plus sensibles à l’expression d’un processus d'inhibition. Cependant, nos résultats ne montrent aucune différence de sensibilité entre les participants chroniquement ostracisés et leurs groupes contrôle (les Études 2 et 3), suggérant une certaine faiblesse du paradigme Cyberball auprès des personnes en situation d'exclusion sociale dans leur vie quotidienne. Nos résultats remettent donc en question la prédominance de ce paradigme pour la compréhension des effets cognitifs de l’exclusion sociale, au moins chez les individus caractérisés par un ostracisme chronique. / Impact on cognitive control, emotions and fundamental needsRésumé : Social exclusion is considered as one of the most painful situations for human beings. Past research showed that even brief episodes of ostracism (the Cyberball paradigm) have strong effects at the neurophysiological, emotional, and behavioral levels, its impact at the cognitive level however did not receive much attention. Recent findings revealed a negative influence of ostracism on electrophysiological markers of cognitive control, yet there is no direct evidence that being socially excluded reduces cognitive control. Here, we investigated the impact of ostracism (using the Cyberball) on cognitive control using a standard Simon task and distributional reaction time analyses with non-chronically-ostracized and chronically-ostracized populations (regular students in Study 1, illiterate people in Study 2, and long-term unemployed people in Study 3). In the three studies, brief episodes of social exclusion had negative effects on participants’ self-reports of fundamental needs' satisfaction (belonging, meaningful existence, self-esteem, and control). These effects, however, were substantially reduced in chronically-ostracized populations, suggesting that ostracism based on the Cyberball is a bit less meaningful for those populations. More importantly, this ostracism caused a transitory reduction in cognitive control in the non-chronically-ostracized participants (Study 1), as indicated by a stable (rather than decreased) Simon effect on longer reaction times where inhibition yet is more likely. However, we found no evidence of a differential sensitivity between the chronically-ostracized participants and their control groups (Study 2 and Study 3), suggesting that the Cyberball paradigm is not powerful enough with people experiencing social exclusion in their ordinary life. Our findings therefore call into question the predominance of the Cyberball paradigm for our understanding of the cognitive effects of ostracism, at least in chronically ostracized-individuals.

Indiana University-Purdue University Indianapolis (IUPUI) / The presence of a chronic pain condition can have a profound impact on one’s self-concept. Some individuals may have had to make major lifestyle changes. As a result, some people may start to define themselves in terms of their pain, such that their self-schema and pain-schemas become intertwined in a process termed schema-enmeshment. It is thought that schema-enmeshment is related to psychological distress making it a prime target for intervention. Little research has been conducted on interventions to reduce schema-enmeshment. Acceptance-based interventions may be especially appropriate in reducing schema-enmeshment or the connection between self and illness symptoms as these interventions tend to emphasize learning to live with pain and other symptoms and to work toward important life goals rather than continually fighting against the condition and allowing it to control their life. This study is a randomized trial comparing Acceptance and Commitment Therapy (ACT) to education about pain management in a sample of women with Fibromyalgia Syndrome (FMS). The primary aim of this study was to assess the efficacy of ACT in reducing schema-enmeshment between self and pain, as well as enmeshment between self and other symptoms and FMS as a whole. In addition, this study also explored the role of pain acceptance, specifically activity engagement as a mediator of the relationship between treatment group membership and changes in schema-enmeshment. The data was analyzed as an intent-to-treat analysis using the “last measure carried forward” method. Results indicated that the ACT group reported statistically significant differences in self schema-enmeshment with FMS, fatigue, and cognitive symptoms, but not with pain, following the intervention, compared to the educational control group. In each of these cases, the ACT group experienced greater reductions in schema-enmeshment compared to the education group. Interestingly, no statistically significant differences were observed for schema-enmeshment with pain. Statistically significant group differences were also observed for acceptance of pain following the intervention. Finally, a mediational model in which changes in activity engagement (a form of pain acceptance) served as the mediator of the relationship between treatment group and changes in schema-enmeshment with FMS was tested. The model was tested using a bootstrapping method, and results revealed a trend toward a significant indirect effect of changes in activity engagement leading to changes in schema-enmeshment with FMS. Taken together, the results of this study indicate that ACT may be a promising intervention for targeting maladaptive beliefs about the self in relation to illness, especially schema-enmeshment of self with illness and illness symptoms. Additionally, there is evidence that ACT may target key constructs such as activity engagement, which may be related to other cognitive and behavioral changes. Future directions for research and clinical practice related to ACT as an intervention for FMS are discussed in depth.

Indiana University-Purdue University Indianapolis (IUPUI) / Stroke is the main cause of disability in the United States. Individuals with stroke commonly report sensory impairment affects their recovery. Motor recovery and sensory impairment are related and impact individuals’ ability to perform valued occupations. Despite the prevalence of sensation impairment after stroke, many occupational therapists fail to include sensation assessment and intervention in treatment planning. The exclusion of sensation in occupational therapy interventions during stroke rehabilitation may be due to the lack of literature supporting the association between sensation and occupational performance. The current study aimed to determine the relationship between touch sensation of the affected hand and occupational performance and satisfaction in individuals with chronic stroke. Using a cross-sectional study design, this study associated factors related to hand sensation and function in individuals with chronic stroke. Fifty individuals with chronic stroke participated in a one-time testing session in which assessments related to sensation, movement of the hand and engagement in daily activities were administered. Correlation analyses were utilized to determine relationships between touch sensation of the affected hand with individuals’ abilities to engage in valued daily activities, arm and hand disability, and manual abilities. The main finding of the study was that individuals with intact sensation reported greater ability to perform valued occupations and satisfaction with their performance, as compared with individuals with touch sensation impairment. For individuals with impaired touch sensation of the affected hand, impairment of touch sensation of the hand did not correlate with individuals’ performance or satisfaction with valued occupations, arm or hand movement, or manual abilities. Collectively, the results of this study reflect the complex interaction between touch sensation, occupational performance, motor functioning, and manual abilities of the affected hand for individuals’ who have experienced a stroke. This study informs therapists, rehabilitation scientists, and other healthcare professionals that client-centered, individualized approaches, including a wide array of clinical assessments and intervention, including assessment of occupational performance and sensation, remain important components in stroke rehabilitation.

Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena. / Graduation date: 2012