A Pilot Randomized Controlled Trial of the Insomnia Coach Mobile App to Assess Its Feasibility,Acceptability, and Potential Efficacy

Insomnia is highly prevalent among military veterans but access to cognitive-behavioral therapy for insomnia (CBT-I) is limited. Thus, this study examined the feasibility, acceptability, and potential efficacy of Insomnia Coach, a CBT-I-based, free, self-management mobile app. Fifty U.S. veterans, who were mostly male (58%) and mean age 44.5 (range = 28–55) years with moderate insomnia symptoms were randomized to Insomnia Coach (n = 25) or a wait-list control condition (n = 25) for 6 weeks. Participants completed self-report measures and sleep diaries at baseline, posttreatment, and follow-up (12 weeks postrandomization), and app participants (n = 15) completed a qualitative interview at posttreatment. Findings suggest that Insomnia Coach is feasible to use, with three quarters of participants using the app through 6 weeks and engaging with active elements. For acceptability, perceptions of Insomnia Coach were very favorable based on both self-report and qualitative interview responses. Finally, for potential efficacy, at posttreatment, a larger proportion of Insomnia Coach (28%) than wait-list control participants (4%) achieved clinically significant improvement (p = .049) and there was a significant treatment effect on daytime sleep-related impairment (d = −0.6, p = .044). Additional treatment effects emerged at follow-up for insomnia severity (d = −1.1, p = .001), sleep onset latency (d = −0.6, p = .021), global sleep quality (d = −0.9, p = .002), and depression symptoms (d = −0.8, p = .012). These findings provide preliminary evidence that among veterans with moderate insomnia symptoms, a CBT-I-based self-management app is feasible, acceptable, and promising for improving insomnia severity and other sleep-related outcomes. Given the vast unmet need for insomnia treatment in the population, Insomnia Coach may provide an easily accessible, convenient public health intervention for individuals not receiving care.     

Self-directed desensitization for acrophobia

Acrophobic outpatients received therapist- or self-directed (tape-recorded) desensitization in a study of (a) treatment effectiveness with diminished therapist contact ; (b) subject characteristics ‘predicting’ outcome; and (c) generalization of change. At Post-test, treated Ss (N=16) had improved significantly more than Waiting List Ss (N=13) on self-report measures of acrophobia and general anxiety, while the treatment methods were equally effective. An 8-month follow-up found that self-directed Ss had attempted more specific behavioral situations than therapist-directed Ss, and showed additional gains on self-report measures while therapist-directed Ss maintained post-test levels. Results suggested: (a) desensitization provides effective treatment even with reduced therapist contact; (b) some subject characteristics relate to outcome and (c) treatment effects generalize to other anxiety indices.     

The development of metacognitive awareness in memory,communication, and attention

Four- and six-year-olds were asked questions about hypothetical situations in which a child was to perform one of three cognitive activities: (1) to remember something, (2) to communicate a message, or (3) to attend to a visual array. Questions focused on the child's understanding of the following four facts about the variables under study: (1) that it is easier to cognize about a shorter than a longer list (length), (2) that it is easier to cognize in the absence of noise than in its presence (noise), (3) that an adult or older child will find a cognitive problem to be easier than will a younger child (age), and (4) that it is generally easier to cognize with more time than with less time (time). Results indicated that the pattern of understanding was the same across the different cognitive activities, that there was a higher level of accuracy in answering questions about length and noise than about age and time, and that, over all, the 6-year-olds were more accurate than the 4-year-olds.     

Further considerations of a general d′ in multidimensional space

Thomas (Psychonom. Bull. Rev. 6 (1999) 224) proposed a generalization of d′,d_g′ for multidimensional distributions and demonstrated that it is not equivalent to Euclidean distance as had been assumed in some previous studies. In this note, it is further shown not to be a metric in the general sense as it fails the triangle inequality. Also, a rigorous proof is offered of the claim (found in Thomas, Psychonom. Bull. Rev. 6 (1999) 224) that in order for the definition of d_g′ to correspond to the quantity that is estimated from data in the traditional way (using hits and false alarms) one must assume a distance classifier (proved in the case of equal covariance matrices). If one assumes optimal responding instead, then the estimated d′ corresponds to (the square root of) Mahalanobis distance. This latter observation clears up an apparent paradox between the fact that d_g′ is not a metric and Ashby and Perrin's (Psychol. Rev. 95 (1988) 124) statement relating the weighted Euclidean scaling model and a signal detection model of similarity that would yield a distance classifier.     

Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD,Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial

This study aimed at evaluating the efficacy of an online CBT intervention with limited therapist contact targeting a range of posttraumatic symptoms among evacuees from the 2016 Fort McMurray wildfires.One hundred and thirty-six residents of Fort McMurray who reported either moderate PTSD symptoms (PCL-5 ≥ 23) or mild PTSD symptoms (PCL-5 ≥ 10) with moderate depression (PHQ-9 ≥ 10) or subthreshold insomnia symptoms (ISI ≥ 8) were randomized either to a treatment (n = 69) or a waitlist condition (n = 67). Participants were on average 45 years old, and mostly identified as White (82%) and as women (76%). Primary outcomes were PTSD, depression, and insomnia symptoms. Secondary outcomes were anxiety symptoms and disability. Significant Assessment Time × Treatment Condition interactions were observed on all outcomes, indicating that access to the treatment led to a decrease in posttraumatic stress (F[1,117.04] = 12.128, p = .001; d = .519, 95% CI = .142–.895), depression (F[1,118.29] = 9.978, p = .002; d = .519, 95% CI = .141–.898) insomnia (F[1,117.60] = 4.574, p = .035; d = .512, 95% CI = .132–.892), and anxiety (F[1,119.64] = 5.465, p = .021; d = .421, 95% CI = .044–.797) symptom severity and disability (F[1,111.55] = 7.015, p = .009; d = .582, 95% CI = .200–.963). Larger effect sizes (d = 0.823–1.075) were observed in participants who completed at least half of the treatment. The RESILIENT online treatment platform was successful to provide access to specialized evidence-based mental health care after a disaster.     

Les intérêts professionnels des collégiens : l'évolution sur un quart de siècle

Two inventories assessing interests of boys (QIG 7,6,5) and of girls (QIF 7,6,5) have been completed by 428 pupils of seventh form in 2004. Results have been compared with those obtained in 1970 and 1976 in comparable studies. On the one hand, appears a fall of the scientific interests and interests for nature and, on the other hand, a rise of the artistic and manual, social and commercial interests. Variations are differentiated for two categories: literary interests are stable among boys and in fall among girls, while sport interests are in rise (G) or stable (F). At last, scores in two specific categories are stable: mechanics (G), domestic (F). These variations seem to follow a general social evolution, but do not modify the differences between genders.     

Impact of Treatment Setting and Format on Symptom Severity Following Cognitive Processing Therapy for Posttraumatic Stress Disorder

Preliminary data suggest cognitive processing therapy (CPT) significantly reduces posttraumatic stress disorder (PTSD) symptom severity among military personnel and veterans when delivered over 12 days and combined with daily recreational activities (Bryan et al., 2018). The present study aimed to examine how therapy pace (i.e., daily vs. weekly sessions) and setting (i.e., clinic vs. recreational) impacts change in PTSD symptom severity. Forty-five military personnel and veterans diagnosed with PTSD chose to receive CPT (a) daily at a recreational facility with recreational programming, (b) daily on a university campus without recreational programming, and (c) weekly on a university campus without recreational programming. PTSD symptom severity was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Reductions in CAPS-5 and PCL-5 scores were large and statistically significant across all three settings (Cohen’s ds > 2.1). As compared to reductions in CAPS-5 and PCL-5 scores in daily therapy at a recreational facility (CAPS-5: d = 1.63–2.40; PCL-5: d = 1.99–2.17), reductions in CAPS-5 and PCL-5 scores were significantly larger in daily therapy on campus, CAPS-5: t(80) = –2.9, p = .005, d = 2.23–2.69; PCL-5: t(78) = 2.6, p = .010, d = 2.54–4.43, but not weekly therapy on campus, CAPS-5: t(80) = 0.2, p = .883, d = 1.04–2.47; PCL-5: t(78) = 1.0, p = .310, d = 1.77–3.44. Participants receiving daily therapy on campus and weekly therapy on campus also had higher rates of clinically significant improvement and good end-state functioning. Results support the effectiveness of CPT across multiple treatment settings and formats and suggest that daily CPT may be less effective when delivered in combination with recreational activities.     

H-Comp: A program to calculate information complexity

Scott’s (1969)H is a statistic that represents the number of independent dimensions in a set of binary (1,0) data.H has been used by personality and social psychologists to measure the complexity of thought people have about themselves (self-complexity) and about other people. This article describesH-Comp, a program that calculatesH. Using data input from either the keyboard or from an ASCII data file,H-Comp calculatesH and writes the resulting score and raw data to output files.H-Comp provides an accurate and efficient way to calculateH.     

The effects of response-reinforcer contingency on time allocation in the open field

The present experiment explores the effects of the response (1-sec occupancy of a target area in an open field)—reinforcer (intracranial stimulation) contingency on time allocation in the open field in rats. The probability of reinforcement given a response (X) and the probability of reinforcement given the absence of a response (Y) were varied randomly across sessions within a subject. The following (X, Y) values were utilized: (.05, 0), (.15, 0), (.25, 0), (.15, .05), and (.15, .15). The results of this experiment indicate that rate of acquisition of time allocation preference is uniformly rapid during all contingency treatments wherein Y = 0 and is negatively related to the value of Y when X = .15. The relationship between the asymptote of the time allocation acquisition function and the value of X (when Y = 0) is positively sloped and negatively accelerated, while the relationship between asymptote and the value of Y (when X = .15) is negatively sloped with zero acceleration. Proposed contingency metrics are evaluated.     

Evidence for distinct clusters of diverse anomalous experiences and their selective association with signs of elevated cortical hyperexcitability

Visual cortical hyperexcitability is now known to be an underlying factor for aberrant visual experience, including hallucinations, and pattern or light induced visual discomfort. Such factors have also been observed in neurological and non-clinical groups (albeit in attenuated form) – consistent with the notion of a continuum of anomalous experiences. Utilizing an exploratory factor analysis (EFA) approach (n = 300), Study 1 developed a revised proxy screening measure for visual cortical hyperexcitability – the Cortical Hyperexcitability index – II(CHi-II). The EFA revealed a stable 3-factor solution which can be characterised as; (i) Heightened Visual Sensitivity and Discomfort (HVSD); (ii) Aura-like Hallucinatory Experience (AHE); and, (iii) Distorted Visual Perception (DVP). Study 2 tested both a self-reported migraine group and a control group on the CHi-II in conjunction with a computerised pattern-glare task that is known to reflect visual cortical hyperexcitability. The migraine group produced significantly elevated scores on both the AHE and HVSD factors of the CHi-II, relative to controls. Among the non-migraine group, subjects who scored higher in the pattern-glare task also produced significantly elevated scores on the AHE factor compared to those with low pattern-glare task scores. Collectively, these findings support the utility of the CHi-II as an indirect proxy measure for signs of cortical hyperexcitability and reveal new categorical distinctions for the nature of the anomalous perceptions. These perceptions may well reflect diverse neurocognitive underpinnings leading to advancements in our understanding of aberrations in conscious experience.     

Comprehension of past and future reference revisited

Sentences containing either past tense, future tense, before, or after were presented with sets of sequential pictures to 150 children from 3 to 7 years. Analysis of errors and correct answers led to the following conclusions: (a) Linguistic factors had a major influence on the results, (b) past and future are understood first as mutually exclusive domains, (c) understanding of linguistic reference to past and future increases gradually from 3 through 7 years, and (d) the ability to temporally decenter increases with age. In addition, before and after were better understood than past or future verb tense. This finding is discussed in terms of (a) the difficulty of establishing the limits of the present in relation to past and future, (b) the center picture serving as a reference point for sentences with before and after, and (c) the difference between understanding reference to three sequenced actions and understanding reference to the sequence of past, present, and future relations.     

Complex problem solving — More than reasoning?

This study investigates the internal structure and construct validity of Complex Problem Solving (CPS), which is measured by a Multiple-Item-Approach. It is tested, if (a) three facets of CPS - rule identification (adequateness of strategies), rule knowledge (generated knowledge) and rule application (ability to control a system) - can be empirically distinguished, how (b) reasoning is related to these CPS-facets and if (c) CPS shows incremental validity in predicting school grade point average (GPA) beyond reasoning. N = 222 university students completed MicroDYN, a computer-based CPS test and Ravens Advanced Progressive Matrices. Analysis including structural equation models showed that a 2-dimensionsal model of CPS including rule knowledge and rule application fitted the data best. Furthermore, reasoning predicted performance in rule application only indirectly through its influence on rule knowledge indicating that learning during system exploration is a prerequisite for controlling a system successfully. Finally, CPS explained variance in GPA even beyond reasoning, showing incremental validity of CPS. Thus, CPS measures important aspects of academic performance not assessed by reasoning and should be considered when predicting real life criteria such as GPA.     

Examining the Validity of Cyclothymic Disorder in a Youth Sample: Replication and Extension

DSM-IV-TR defines four subtypes of bipolar disorder (BP): bipolar I, bipolar II, cyclothymic disorder and bipolar not otherwise specified (NOS). However, cyclothymic disorder in children is rarely researched, or often subsumed in an “NOS” category. The present study tests the replicability of findings from an earlier study, and expands on the criterion validity of cyclothymic disorder in youth. Using the Robins and Guze (1970) framework we examined the validity of cyclothymic disorder as a subtype of BP. Using a youth (ages 5–17) outpatient clinical sample (N?=?894), participants with cyclothymic disorder (n?=?53) were compared to participants with other BP spectrum disorders (n?=?399) and to participants with non-bipolar disorders (n?=?442). Analyses tested differences in youth with cyclothymic disorder and bipolar disorder not otherwise specified who do, and those who do not, have a parent with BP. Compared to youth with non-bipolar disorders, youth with cyclothymic disorder had higher irritability (p?<?0.001), more comorbidity (p?<?0.001), greater sleep disturbance (p?<?0.005), and were more likely to have a family history of BP (p?<?0.001). Cyclothymic disorder was associated with a younger age of onset compared to depression (p?<?0.001) and bipolar II (p?=?0.05). Parental BP status was not significantly associated with any variables. Results support that cyclothymic disorder belongs on the bipolar spectrum. Epidemiological studies indicate that cyclothymic disorder is not uncommon and involves significant impairment. Failing to differentiate between cyclothymic disorder and bipolar NOS limits our knowledge about a significant proportion of cases of bipolarity.     

Experimentally induced phonological paraphasias.

A motor aphasic patient had to repeat word lists that contained, among other things, words with the sequences r - r - l and l - l - r. These sequences were often repeated as l - r - l (anticipatory distant assimilation) and r - l - r (same type, but less frequently), respectively. These assimilations violate the cross-over constraint (or relevancy condition or adjacency principle) and thus represent another instance of a flagrant contradiction between pathological and normal (natural) phonological processes.     

Position of compression garment around the knee affects healthy adults’ knee joint position sense acuity

Athletes use compression garments (CGs) to improve sport performance, accelerate rehabilitation from knee injuries or to enhance joint position sense (JPS). The position of CGs around the knee may affect knee JPS but the data is inconsistent. The purpose of the present study was to determine the effects of CG position on healthy adults’ knee joint position sense acuity. In a counterbalanced, single-blinded study, 16 healthy young adults (8 female, age: 25.5 y) performed an active knee joint position-matching task with and without (CON) a below-knee (BK), above-knee (AK), or whole-knee (WK) CG in a randomized order on the dominant (CompDom) or the non-dominant leg (CompNon-Dom). We also determined the magnitude of tissue compression by measuring anatomical thigh and calf cross sectional area (CSA) in standing using magnetic resonance imaging (MRI). Subjects had less absolute repositioning error (magnitude of error) in BK compared with CON condition. On the other hand, the analysis of the direction of error (constant error) revealed that in each condition subjects tended to underestimate the target position (AK, BK and CON: 75%; WK: 94%). In WK condition there was a significantly larger negative error (−2.7 ± 3.4) as compared with CON (−1.6 ± 3.7) condition. There also was less variable error, in WK compared to BK and CON conditions, indicating less variability in their position sense using a WK CG, regardless of the underestimation. CG reduced thigh CSA by 4.5 cm² or 3% and calf CSA by Δ1.3 cm² or 1%. The position of CG relative to the knee modifies knee JPS. The findings helps us better understand how the application of a WK CG may support athletic activities.     

“The Lesser of Two Evils”: Islamic Law and the Emergence of a Broad Agreement on Muslim Participation in Western Political Systems

Through an analysis that focuses on wasati and salafi fatwas, but searches also beyond them, this article demonstrates the emergence of a broad agreement (albeit not a consensus) in Islamic jurisprudence on the permissibility of political participation in the West. This broad agreement is based primarily on jurists’ evaluation, drawing on ‘fiqh al-muwazanat’ (the jurisprudence of balances) that, in some cases, participation brings more benefit (maslaha) than harm (mafsada). The article comparatively examines wasati and salafi approaches to politics and to Muslim minorities to explain why jurists who disagreed on other fundamental issues in the field of fiqh al-aqalliyyat al-Muslima (the religious law of Muslim minorities) reached similar (but not identical) conclusions on political participation. Based on this analysis, a revision of some prevailing categorizations of salafiyya is suggested. Deliberations by some salafis, jihadi-salafis and members of Hizb al-Tahrir who oppose political participation and their refutations of the justifications invoked by jurists who legitimized it are also examined.     

Instrumental learning in preschool children as a function of type of task, type of reward, and some organismic variables

The effects on instrumental behavior of differences in type of task, type of reward and three organismic variables were investigated in preschool children. The main results were that: (a) an imitative task was acquired in fewer trials than a nonimitative task; (b) social reward in acquisition led to greater resistance to extinction; (c) a history of frequent social reinforcement from peers led to persistence in responding during extinction for boys only; (d) extraversion was found to interact with the variables of task and reward in errors made during extinction; and (e) intelligence was not found to be a reliable predictor of main acquisition and extinction measures or related errors. Detailed analysis of the different types of errors contributed directly to the interpretation of these findings.     

Measured and predicted mechanical internal work in human locomotion

Predictive methods estimating mechanical internal work (W_int, i.e., work to accelerate limbs with respect to BCOM during locomotion) are needed in absence of experimental measurements. A previously proposed model equation predicts such a parameter based upon velocity, stride frequency, duty factor, and a compound critical term (q) accounting for limb geometry and inertial properties. That first predicted W_int estimate (PW_int) has been validated only for young males and for a limited number of horses. The present study aimed to extend the comparison between model predictions and experimentally measured W_int (MW_int) data on humans with varying gender, age, gait, velocity, and gradient. Seventy healthy subjects (males and females; 7 age groups: 6-65 years) carried out level walking and running on treadmill, at different velocities. Moreover, one of the subject groups (25-35 years) walked and ran also at several uphill/downhill gradients. Reference values of q represent the main important results: (a) males and females have similar q values; (b) q is independent on velocity and gradient. Also, different data filtering depth was found to affect MW_int and, indirectly, PW_int, thus also the reference q values here obtained (0.08 in level, 0.10 in gradient) suffer a - 20% underestimation with respect to the previous predicting model. Despite of this effect, the close match between MW_int and PW_int trends indicates that the model equation could be satisfactorily applied, in various locomotion conditions.     

Can a Single Measure Estimate Protocol Adherence for Two Psychosocial Treatments for Youth Anxiety Delivered in Community Mental Health Settings?

Treatment adherence measurement can be time and resource-intensive in clinical trials, so the ability to measure protocol adherence for two distinct treatment programs with a single measure may benefit the field. The present study sought to determine if the Therapy Process Observational Coding System – Revised Strategies Scale (TPOCS-RS) could assess protocol adherence to two youth treatment programs. Treatment sessions (N = 796) from 55 youth (M age = 9.89 years, SD = 1.71; range 7–15 years; 55.0% White; 46.0% female) with primary anxiety problems treatment by 39 clinicians (M age = 40.54 years, SD = 9.56; 50.0% White; 80.0% female) were independently scored by coders using observational treatment adherence and alliance measures. The youth received one of three treatments: (a) Standard (i.e., cognitive-behavioral treatment program), (b) Modular (i.e., a program with cognitive-behavioral and parent training components), or (c) Usual Care. Consultants filled out a self-report measure of protocol adherence within the Standard and Modular conditions. Interrater reliability, ICC(2,2) for the various items for the full sample ranged from .17 to .92 (M ICC = .67; SD = .17). Scores from a TPOCS-RS subscale that mapped onto the specific content of the treatment protocols used in the Standard and Modular conditions evidenced convergent validity with the consultant-report adherence measure and discriminant validity with the alliance measure. The model-specific TPOCS-RS subscales also discriminated between the Standard and Modular treatments and Usual Care. This study provides initial evidence that (a) the TPOCS-RS has utility in estimating protocol adherence in different treatment programs and (b) support the score validity of the self-report consultation records.