Coping skills and exposure therapy in panic disorder and agoraphobia: latest advances and future directions

Although cognitive-behavioral treatments for panic disorder have demonstrated efficacy, a considerable number of patients terminate treatment prematurely or remain symtpomatic. Cognitive and biobehavioral coping skills are taught to improve exposure therapy outcomes but evidence for an additive effect is largely lacking. Current methodologies used to study the augmenting effects of coping skills test the degree to which the delivery of coping skills enhances outcomes. However, they do not assess the degree to which acquisition of coping skills and their application during exposure therapy augment outcomes. We examine the extant evidence on the role of traditional coping skills in augmenting exposure for panic disorder, discuss the limitations of existing research, and offer recommendations for methodological advances.     

The enduring impact of borderline personality pathology: risk for threatening life events in later middle-age

Both neuroticism and borderline personality disorder (BPD) are associated with increased frequency of stressful life events in young adults. It is not clear, however, whether this effect extends to later life because BPD is apparently diminished in frequency and severity when people reach middle adulthood. This issue was examined in a representative, community sample of men and women between the ages of 55 and 64 (N = 1,234). Ten DSM-IV PDs and neuroticism were assessed at baseline using a semistructured interview (SIDP-IV) and questionnaire (NEO-PI-R). Life events were measured 6 months later with a self-report questionnaire (LTE-Q) followed by a telephone interview. BPD features and neuroticism predicted increased frequency of life events, based on both self and interviewer-adjusted reports of negative life events. Avoidant and paranoid PD features predicted decreased frequency of negative life events. Approximately 42% of events reported on the LTE-Q were discounted following the telephone interview; higher scores on BPD symptoms were associated with more adjustments to self-report of threatening experiences. These findings indicate that symptoms of BPD and neuroticism continue to have a harmful impact on the lives of older adults.     

Borderline but not antisocial personality disorder symptoms are related to self-reported partner aggression in late middle-age

We examined the relationship between personality pathology and the frequency of self-reported psychological and physical partner aggression in a community sample of 872 adults aged 55-64. Previous research suggests that antisocial and borderline personality disorder (PD) symptoms are associated with partner aggression. Controlling for gender, education, alcohol dependence, and other personality pathology, we found that borderline PD symptoms, which include abandonment fears, unstable identity, and affective instability, were significantly related to the frequency of self-reported aggression toward one's partner. This relationship was observed regardless of whether the participant's personality was described by a clinical interviewer, the participant themselves, or an informant chosen by the participant. Further, the relationship between borderline PD symptoms and self-reported partner aggression was moderated by gender such that women were driving the association. Conversely, antisocial PD symptoms, which include deceitfulness, irresponsibility, disregard for rules, and lack of remorse did not significantly account for variance in self-reported partner aggression. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The Children's Behavior Questionnaire very short scale: psychometric properties and development of a one-item temperament scale

Little research has been conducted on the psychometrics of the very short scale (36 items) of the Children's Behavior Questionnaire, and no one-item temperament scale has been tested for use in applied work. In this study, 237 United States caregivers completed a survey to define their child's behavioral patterns (i.e., Surgency, Negative Affectivity Effortful Control) using both scales. Psychometrics of the 36-item Children's Behavior Questionnaire were examined using classical test theory, principal factor analysis, and item response modeling. Classical test theory analysis demonstrated adequate internal consistency and factor analysis confirmed a three-factor structure. Potential improvements to the measure were identified using item response modeling. A one-item (three response categories) temperament scale was validated against the three temperament factors of the 36-item scale. The temperament response categories correlated with the temperament factors of the 36-item scale, as expected. The one-item temperament scale may be applicable for clinical use.     

2D:4D in men is related to aggressive dominance but not to sociable dominance

It has been shown that a smaller ratio between the length of the second and fourth digit (2D:4D) is an indicator of the exposure to prenatal testosterone (T). This study measured the 2D:4D of men and assessed dominance as a personality trait to investigate indirectly if the exposure to prenatal T is related to a dominant personality later in life. Results showed that men had a more aggressive dominant personality when having a more masculine (lower) 2D:4D, while there was no relationship between sociable dominance and 2D:4D. Findings from this study indicate that it is important to distinguish different forms of dominance since other studies failed to find relationships between dominance and 2D:4D.     

The meaning in empathy: distinguishing conceptual encoding from facial mimicry, trait empathy, and attention to emotion

In order to truly empathise with another, we need to recognise and understand how they feel. Perception-action models of empathy predict that attending to another's emotion will spontaneously activate the observer's own conceptual knowledge for the state, but it is unclear how this activation is related to facial mimicry, trait empathy, or attention to emotion more generally. In the current study, participants did spontaneously encode background facial expressions at a conceptual level even though they were irrelevant to the task (the Emostroop effect; Preston & Stansfield, 2008), but this encoding was not associated with mimicry of the faces, trait empathy, the ability to resolve competing semantic representations (Colour-naming Stroop task), or the tendency to be distracted by emotional information more generally (Intrusive Cognitions task). Our results suggest that trait empathy increases attention to emotional information, but conceptual encoding occurs across individuals as a natural consequence of attended perception.     

Child and adolescent development: common mental disorders according to age and gender

Despite the increase in the incidence and prevalence rates of children and adolescents' mental disorders, there are few works performed with large and representative samples of children and adolescents with psychopathological symptoms. The present work analyses 588 participants referred by first care pediatricians to a specialized unit for children and adolescents' mental health. As a result of the study, a statistically significant relation was found between age and diagnosis: a larger incidence of behavioral disorders, communication disorders, elimination disorders, pervasive developmental disorders, impulse-control disorders from 0 to 5 years; behavioral disorders and attention deficit hyperactivity disorder (ADHD) were more common from 6 to 11 years, behavioral and anxiety disorders were more likely at 12 to 15 years; and, lastly, behavioral disorders were more prevalent from 16 to 18 years. With respect to gender, there was a significant relationship with diagnosis: boys had more behavioral disorders, whereas girl had more anxiety disorders. To conclude, a relationship between mental disorders and developmental achievements could be indicated in the younger group. Additionally, externalizing disorders in boys and internalizing ones n girls were more prevalent across all ages.     

Attenuated response to methamphetamine sensitization and deficits in motor learning and memory after selective deletion of β-catenin in dopamine neurons

In the present study, we analyzed mice with a targeted deletion of β-catenin in DA neurons (DA-βcat KO mice) to address the functional significance of this molecule in the shaping of synaptic responses associated with motor learning and following exposure to drugs of abuse. Relative to controls, DA-βcat KO mice showed significant deficits in their ability to form long-term memories and displayed reduced expression of methamphetamine-induced behavioral sensitization after subsequent challenge doses with this drug, suggesting that motor learning and drug-induced learning plasticity are altered in these mice. Morphological analyses showed no changes in the number or distribution of tyrosine hydroxylase-labeled neurons in the ventral midbrain. While electrochemical measurements in the striatum determined no changes in acute DA release and uptake, a small but significant decrease in DA release was detected in mutant animals after prolonged repetitive stimulation, suggesting a possible deficit in the DA neurotransmitter vesicle reserve pool. However, electron microscopy analyses did not reveal significant differences in the content of synaptic vesicles per terminal, and striatal DA levels were unchanged in DA-βcat KO animals. In contrast, striatal mRNA levels for several markers known to regulate synaptic plasticity and DA neurotransmission were altered in DA-βcat KO mice. This study demonstrates that ablation of β-catenin in DA neurons leads to alterations of motor and reward-associated memories and to adaptations of the DA neurotransmitter system and suggests that β-catenin signaling in DA neurons is required to facilitate the synaptic remodeling underlying the consolidation of long-term memories.     

Brief Acceptance and Commitment Therapy and Exposure for Panic Disorder: A Pilot Study

Cognitive and biobehavioral coping skills are central to psychosocial therapies and are taught to facilitate and improve exposure therapy. While traditional coping skills are aimed at controlling maladaptive thoughts or dysregulations in physiology, newer approaches that explore acceptance, defusion, and values-based direction have been gaining interest. Acceptance and Commitment Therapy (ACT) involves creating an open, nonjudgmental stance toward whatever thoughts, feelings, and bodily sensations arise in a given moment, experiencing them for what they are, and moving toward them while inner experiences such as anxiety are present. This approach can be seen as consistent with exposure therapies and may be utilized to organize and facilitate engagement in exposure exercises. This study examines the feasibility and efficacy for combining a brief ACT protocol with traditional exposure therapy. Eleven patients with panic disorder with or without agoraphobia received 4 sessions of ACT followed by 6 sessions of exposure therapy, with data collected on a weekly basis. Acquisition of ACT skills and their application during exposure was monitored using a novel “think-aloud” technology. Treatment was associated with clinically significant improvements in panic symptom severity, willingness to allow inner experiences to occur, and reductions in avoidant behavior. Although preliminary, results suggest that our brief training in ACT only (as assessed prior to exposure exercises) and in combination with exposure therapy was acceptable to patients and offered benefits on the order of large effect sizes. Clinical and research implications are discussed.     

The role of optimism and pessimism in chronic pain patients adjustment

This study analyses the relationships between patients' dispositional optimism and pessimism and the coping strategies they use. In addition, the coping strategies repercussions on adjustment to chronic pain were studied. Ninety-eight patients with heterogeneous chronic pain participated. The assessment tools were as follows: Life Orientation Test (LOT), the Vanderbilt Pain Management Inventory (VPMI), the McGill Pain Questionnaire (MPQ), Hospital Anxiety and Depression Scale (HADS), and the Impairment and Functioning Inventory for Chronic Pain Patients (IFI). The hypothetical model establishes positive relationships between optimism and the use of active coping strategies, whereas pessimism is related to the use of passive coping. Active coping is associated with low levels of pain, anxiety, depression and impairment and high levels of functioning. However, passive coping is related to high levels of pain, anxiety, depression and impairment and low levels of functioning. The hypothetical model was empirically tested using the LISREL 8.20 software package and the unweighted least squares method. The results support the hypotheses formulated regarding the relations among optimism, pessimism, coping and adjust of chronic pain patients. By analysing optimism among chronic pain patients, clinicians could make better predictions regarding coping and adjustment.