Does Exposure and Response Prevention Behaviorally Activate Patients With Obsessive-Compulsive Disorder? A Preliminary Test

Exposure and response prevention (ERP) and behavioral activation (BA) are effective treatments for obsessive-compulsive disorder (OCD) and depression, respectively. Patients with OCD often exhibit depression; furthermore, ERP for OCD is associated with reduced depressive symptoms. To our knowledge, no study has examined whether ERP itself functions to behaviorally activate patients with concurrent OCD and depressive symptoms. This prospective study was designed to test the hypotheses that (a) OCD exposure hierarchy completion, increased BA, and depressive symptom reduction would all be related, and (b) pre- to posttreatment changes in BA would mediate the direct effect of OCD hierarchy completion on posttreatment depressive symptoms, even after controlling for pretreatment depressive symptoms, pretreatment BA, pre- to posttreatment reductions in OCD symptoms, treatment duration, and antidepressant medication use. Patients (N = 90) with a primary diagnosis of OCD who received residential ERP for OCD completed a self-report battery at pre- and posttreatment. Exposure hierarchy completion, increases in BA, and decreases in depression were all significantly correlated (rs ranged .33 to .44). The effect of hierarchy completion on posttreatment depressive symptoms was fully mediated by pre- to posttreatment changes in BA. Findings highlight the potential for ERP to exert antidepressant effects by behaviorally activating patients. Limitations, clinical implications, and future directions are discussed.     

Psychopathy and APD in Non-forensic Patients: Improved Predictions or Disparities in Cut Scores?

Psychopathy has traditionally been viewed as a distinct syndrome that is superior to Antisocial Personality Disorder (APD) for the prediction of violent and aggressive behavior. However, direct comparisons of psychopathy and APD are infrequent and mostly occur in correctional populations. Moreover, any observed differences could simply reflect a disparity in cut scores. The constellation of Psychopathy Checklists (PCL-R, PCL:SV, and PCL:YV) set the minimum cut score at 75% (e.g., ≥30 of 40 for the PCL-R), which is far more stringent than what is required for the DSM-IV APD adult criteria (i.e., ≥ 3 of 7 or 42.9%). For use in a non-forensic setting, we re-examined the MacArthur Risk Assessment data set to evaluate the usefulness of the PCL:SV and APD for short-term predictions of violent and aggressive acts. Using the ≥75% cut score to predict violence produced low sensitivities for both the psychopathy (.18) and APD adult criteria (.14) but very high specificities (.94). Reducing the cut score to approximately 40% greatly improved sensitivity rates (.62 for psychopathy and .85 for Adult APD criteria) at the expense of specificity (.59 and .40 respectively). In making multiple comparisons, psychopathy did not appear superior to APD adult criteria in predicting violent or other aggressive behavior. Instead, both constructs had limited predictive power with patients in a non-forensic setting. On an item level, specific indicators of violent behavior were explored.     

Client Versus Clinicians’ Standards of Clinically Meaningful Change and the Effects of Treatment Expectations on Therapeutic Outcomes in Individuals With Posttraumatic Stress Disorder

There is limited research on the concordance between client perceptions and clinician standards of the degree of symptom change required to achieve meaningful therapeutic improvement. This was investigated in an adult sample (N = 147) who received trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD). We examined whether clients’ benchmarks of change were related to actual outcomes and the relationship between client expectations and their treatment outcomes. Clients completed measures indexing the level of symptom reduction required (in their view) to reflect a benefit or recovery from treatment and treatment expectations. Actual PTSD severity was indexed pre- and posttreatment via self-report and clinician-administered interview. Results demonstrated that the amount of change clients said they required to experience a benefit or recovery was significantly larger than typical clinical research standards. Nonetheless, the majority of client benchmarks of change (79.7–81.8%) were consistent with clinical research standards of what constitutes benefit or recovery. Client benchmarks were generally positively correlated with their actual outcomes. Clients’ belief that treatment would be successful was associated with greater reductions in PTSD symptoms. These findings provide preliminary evidence that the standards used to determine clinically significant change are somewhat consistent with clients’ own perceptions of required symptom change.     

Slacking Off or Winding Down? An Experience Sampling Study on the Drivers and Consequences of Media Use for Recovery Versus Procrastination

Today's constant availability of media content provides users with various recreational resources. It may also challenge self‐control, however, once media exposure conflicts with other goals and obligations. How media users deal with these self‐regulatory chances and risks in their daily lives is largely unknown. Our study addressed the predictors and consequences of recreational and procrastinatory media use using experience sampling methodology (N = 215; 1,094 media use episodes). Results suggest that trait (self‐control, performance goal orientation) as well as state variables (exhaustion) are significant predictors of media use for recovery versus procrastination. Whereas recreational media use showed a positive effect on entertainment, which in turn enhanced subjective well‐being, negative self‐evaluation elicited by procrastinatory media use negatively affected well‐being.     

Head Over the Heart or Heart Over the Head? Cognitive Experiential Self‐Theory and Extralegal Heuristics in Juror Decision Making1

Cognitive experiential self‐theory (CEST), which maintains that information can be processed in both an experiential (emotional) and a rational mode. Experiential processing fosters a reliance on heuristic cues. Previous research has demonstrated that juror verdicts are influenced by a variety of extralegal heuristics, including a defendant attractiveness cue. This research examined whether experiential processing would produce a defendant‐attractiveness/leniency effect. Before awarding monetary damages in a civil trial, participants were motivated to think either rationally or experientially and were shown a photograph of either a high‐ or low‐attractiveness defendant. Experiential mode participants awarded significantly lower damages to the plaintiff when the defendant was attractive, but the attractiveness‐leniency effect was not operative for rational mode participants.     

Crossing road intersections in old age—With or without risks? Perceptions of risk and crossing behaviours among the elderly

Pedestrians aged over 65 are known to be a critical group in terms of road safety because they represent the age group with the highest number of fatalities or injured persons in road accidents. It is widely recognized that the latter is due to the physical vulnerability of this age group in case of injury. However, physical and cognitive decline come into play during the action of crossing a street. Various studies have attempted to connect the crossing behaviours of the elderly with variables such as age, gender, sensory acuity, level of attentiveness, physical decline and the design of intersections. In demonstrating the complexity of the relationship between people and their environments, the literature suggests that age, physical ability, and the spatial configuration of roads are major components of road safety. Moreover, people’s knowledge and mastery of their environments, as well as their ability to adapt to change affects how they move through space. Taking these factors into account, this study examines the perceptions of elderly pedestrians with regards to the quality and risks of road crossings in the context of Montréal, Québec, in Canada. The analyze are based on observations and questionnaires in order to bring to light a better understanding of the relationship between the crossing behaviours, characteristics and perceptions of the elderly. While previous studies have examined perception and observation separately, this study is unique in having looked at both angles simultaneously. Five profiles of elderly people in both urban and suburban environments were established. A sample of 181 elderly pedestrians (65–93 years of age, AVG = 74) were surveyed using a questionnaire. In addition to close-ended questions, respondents were asked to evaluate 17 environmental ambiance and risk behaviours according to various scales. Using principal component analysis (PCA) and hierarchical cluster analysis (HCA), the data was grouped into 6 categories that define and distinguish 7 profiles of elderly people. These profiles were explored according to the socioeconomic status and crossing behaviours of respondents. The probabilities of adopting different crossing behaviours were tested by employing logistic regression models. The results reveal greater variability in the perceptions of the elderly in terms of risk related to crossing behaviours and type of signalisation at intersections. Even among seniors, the perceptions of risk varied greatly, which may have had an impact on their behaviours. While some of the behaviours observed coincided with the perceptions of respondents, the results of this study suggest that they only play a marginal role.     

The Impact of Religiosity and Individual Prayer Activities on Advanced Cancer Patients’ Health: Is There Any Difference in Function of Whether or Not Receiving Palliative Anti-neoplastic Therapy?

Consecutive patients (n = 221) presenting for initial consultation at a palliative care outpatient clinic were prospectively interviewed and then followed until death. Individual prayer activity (IPA) and global religion scores were associated with quality of life, symptoms, inflammatory markers, and survival. Analyses were adjusted for whether patients were still receiving anti-neoplastic therapies (ANTs) or not. Higher religion scores were associated with lower levels of inflammation in advanced cancer patients still undergoing ANTs. Additionally, higher IPA was an independent good prognostic factor in patients on active ANTs. Further studies are necessary to confirm these findings and to investigate possible biological mechanisms involved.