Predictors of short-term treatment outcome in bulimia nervosa inpatients.

Recent studies, mostly performed on bulimic outpatients, did not find consistent predictors of treatment outcome in bulimia nervosa. This is the first study to investigate anamnestic and clinical factors predictive of the short-term outcome of hospital treatment in 31 female bulimia nervosa patients with a mean age of 22.9 yr. Treatment outcome was assessed by several self-rating instruments measuring different features of the specific and unspecific psychopathology of bulimia nervosa. The most relevant predictors of the outcome of the 8-week hospital treatment were duration of previous inpatient treatments for bulimia, the intensity of anorexic tendency and the pretreatment level of depression. The majority of predictors tested did not show a strong relationship to treatment outcome. The findings are discussed in relation to results of other studies as well as to possible implications for treatment and research.     

Psychological factors in abortion. A review.

Psychological research is increasingly involved in debates regarding abortion. While recognizing the diversity of ethical and moral issues intertwined with abortion, the American Psychological Association (APA) has focused its involvement on psychological factors, most recently by appointing an expert panel to review the literature on psychological effects. This article notes the history of APA involvement and reports on the panel's conclusions. It presents evidence that abortion is not likely to be followed by severe psychological responses and that psychological aspects can best be understood within a framework of normal stress and coping rather than a model of psychopathology. Correlates of more negative responses following abortion are also discussed.     

Cue-exposure vs self-control in the treatment of binge eating: a pilot study.

From a recent theory on the learned nature of craving responses and binge eating, it follows that craving will extinguish when the CS-US bond is broken by prolonged exposure to the cues predicting excessive food intake with response prevention. The present authors treated six obese bulimics with cue exposure and response prevention. Six other patients learned to avoid or escape the binge-related cues with the aid of self control techniques. Although both treatments appeared to be effective in reducing the binge frequency, a most remarkable finding of the present study is that all patients treated by cue exposure were abstinent, directly after treatment and during the 1 yr follow-up. In contrast to the 100% binge-free subjects treated by cue exposure, self control techniques and relapse prevention led to abstinence in merely 33% of the subjects.     

Orientation congruency effects in visual search.

Subjects searched for the letter E in a background of Ls and Fs in displays that had 1, 2, 4, 8, or 12 letters. The letters could be shown at one of six orientations (upright or rotated clockwise in 60 degrees increments). The displays were either congruent for orientation (all letters had the same orientation) or incongruent (letters in haphazard orientations except for the target on E-present trials). Search time increased linearly with the number of letters in the display, and more so for E-absent trials than for E-present trials. Letter orientation, in general, increased search time and produced an M-shaped function. Furthermore, orientation effects were attenuated in congruent displays relative to those produced by incongruent displays. The results demonstrated systematic orientation effects on the time to search for a simple pattern embedded in simple backgrounds, and provided converging evidence for the orientation-congruency effect found by Jolicoeur (1990b, Journal of Experimental Psychology: Human Perception and Performance, 16, 351-364).     

Reaction time to threat stimuli in panic disorder and social phobia

Two studies assessed response time among clinically anxious subjects and normal controls when presented with threat, positive and neutral stimuli under perceptual (lexical decision) and semantic (category decision) task conditions. In Study 1, panic disorder subjects' (n = 14) performance was compared to that of matched normal controls (n = 14) while in Study 2 social phobic subjects (n = 24) were compared to matched normal controls (n = 24). Relative to matched normal controls, panic disorder subjects but not social phobics tended to show greater slowing in performance on the more cognitively complex (category) task. A second finding, consistent across both studies was that, compared to the normal control groups, both panic and social phobic groups showed significantly slowed responses to threat words in both the perceptual and semantic tasks. Such findings are directly counter to the predictions of a mood congruence hypothesis. This apparent contradiction is resolved by a review of the literature which indicates that mood-related facilitation effects are obtained only in tasks which tap awareness of threat information rather than speed of response. It is suggested that while anxiety may produce enhanced awareness of threat, it may inhibit responsiveness to it. The results of these studies are seen as consistent with ethological theories of inhibited motoric responses under certain threat conditions. Furthermore, the findings suggest that caution is indicated in interpreting slowed reaction time to threat stimuli in tasks such as the Stroop color naming task as purely the result of attentional processes.     

Physical symptoms and illness attributions in agoraphobia and panic.

The cognitive model of panic disorder proposes that panic patients interpret physical symptoms in a catastrophic way, thus precipitating panic attacks. This study describes the development of a questionnaire measure designed to assess beliefs about the health implications of various symptoms. Two groups, agoraphobics and normals, were compared on a variety of measures. Agoraphobics showed much higher panic frequency, fear of anxiety, and prevalence of frightening cognitions when anxious, but did not score higher than normals when assessing seriousness of symptoms. The implications of these results are considered.     

Emergenesis. Genetic traits that may not run in families.

Traits that are influenced by a configuration--rather than by a simple sum--of polymorphic genes may not be seen to be genetic unless one studies monozygotic twins (who share all their genes and thus all gene configurations) because such "emergenic" traits will tend not to run in families. Personal idiosyncrasies that have been found to be surprisingly concordant among MZ twins separated in infancy and reared apart may be emergenic traits. More speculatively, important human traits like leadership, genius in its many manifestations, being an effective therapist or parent, as well as certain psychopathological syndromes may also be emergenic. These ideas reemphasize the importance of the role played in human affairs by genetic variation.     

Scientific rewards and conflicts of ethical choices in human subjects research.

The primary responsibility of the American Psychological Association's (APA) Committee on Standards in Research (CSR) is to advise the APA on issues and standards related to the protection of human participants in psychological research. A related goal is to enhance the use of good ethical practices by APA members. The purpose of this article is to foster the view of research ethics not as an affront to the integrity of sound research, but as opportunities for scientific rewards, including increased understanding of the meaning of data, enhanced recruitment, and the inclusion of more representative samples. Three ethical practices are discussed as examples of this general premise: respect for confidentiality, use of debriefing, and assurance that participants are noncoerced volunteers. The Committee's intent is to promote consideration of these issues, not to promulgate specific guidelines or procedures.