Acceptability of virtual reality interoceptive exposure for the treatment of panic disorder with agoraphobia

Interoceptive exposure (IE) is a standard component of cognitive-behavioural therapy (CBT) for panic disorder and agoraphobia. The virtual reality (VR) program ‘Panic-Agoraphobia’ has several virtual scenarios designed for applying exposure to agoraphobic situations; it can also simulate physical sensations. This work examines patients' acceptability of the IE component as applied in two different ways: using VR versus traditional IE. Additionally, it explores the relationship between users' treatment expectations and satisfaction and clinically significant change. Results showed that VR and traditional IE were well accepted by all participants. Furthermore, treatment expectations predicted efficacy.     

Succeeding in Rural Mental Health Practice: Being Sensitive to Culture by Fitting in and Collaborating

Sustainable solutions to the access to mental health care problems are complex and must address both the availability of mental health care resources and the acceptability of those resources to consumers. The purpose of this study was to determine how to address the acceptability problem by learning from medical and mental health care providers what mental health therapists need to know to be successful in providing care in rural communities. Using a qualitative design, focus groups were conducted in three rural communities (<2,500) with medical and mental health care providers practicing in these communities. Data were analyzed using inductive qualitative methods. Results indicate that in addition to sound clinical skill, mental health therapists should (A) be sensitive to the culture of the rural community in which they are working and (B) practice in a way that accommodates to the care culture of the community. The latter includes spending time with patients commensurate with what is expected by other providers, engaging in generalist practice, and collaborating with local providers in patient care. An important implication of these results is that mental health care must be acceptable to both the residents of the community and the gatekeepers to health care.     

Older Workers with Disabilities: Job Satisfaction Differences in the Public and Private Sectors in Europe

This study analyzes the differences in job satisfaction of older European people (aged 50-64), with or without disabilities, who are employed in either the public or the private sector. Using the data taken from the Survey of Health, Ageing and Retirement in Europe (SHARE) for the years 2004, 2007 and 2011, job satisfaction equations are estimated for workers from both the public and private sectors, with panel data techniques that include variables related to the worker's degree of disability (nondisabled, non-limited disabled, and limited disabled), among others. The results show that the disabled workers who are limited in their everyday activities are less satisfied in both the public and private sectors than those who are non-disabled and non-limited. In addition, the levels of job satisfaction for non-limited disabled people are higher than their non-disabled counterparts but only in the public sector. From a point of view of public policies, it is necessary to design and undertake measures and actions that would contribute to improving the levels of job satisfaction of older workers with disabilities, especially among those who are limited in their everyday activities.     

The update of semantic memories in amnestic mild cognitive impairment

It is still controversial to what extent neocortical consolidated memories are susceptible of change by processes of reconsolidation and transformation throughout experience, and whether the medial temporal lobes are necessary for this update of semantic consolidated memories, as they are for episodic remembering. We hypothesize that patients with amnestic mild cognitive impairment (aMCI) who have deficits in episodic memory may also have difficulties in updating information on added new features of objects. Sixteen participants with aMCI and 20 healthy control participants performed a semantic word-to-picture task, in which they were asked to identify as belonging to a given semantic category NEW objects, that have incorporated novel features, as well as OLD items, semantically and visually SIMILAR items and UNRELATED items. Patients with aMCI made a greater percentage of errors than healthy controls. Participants globally made greater percentages of errors in difficult types of items, namely NEW and SIMILAR, as compared to easier ones, OLD and UNRELATED. Importantly, an item by diagnostic group interaction effect was observed, and post hoc analysis showed that patients with aMCI made a higher percentage of errors than controls in NEW items only. In conclusion, patients with aMCI had a particular difficulty in identifying the NEW items of the word-to-picture task as compared to the control participants, supporting the concept of a flexible and dynamic conceptual knowledge system, involving the update of semantic memories and the integration of new attributes in a constant transformation process, which is impaired in these patients.     

Developmental and medical factors associated with parenting stress in mothers of toddlers born very preterm in a neonatal follow-up clinic

The purpose of this exploratory, cross-sectional study was to identify child-related factors associated with maternal parenting stress in toddlers born very preterm and followed in a neonatal follow-up (NFU) clinic. The study aimed to describe the associations of current medical complications and presence of developmental delays with total parenting stress. Participants were 53 mother–child dyads presenting in a NFU clinic. Mothers completed the Parenting Stress Index-Short Form (PSI-SF), and children were administered the Brigance Early Head Start Screen II. Medical variables were also collected from the child's medical record. Approximately 24% of mothers had at least one elevated subscale score on the PSI-SF. Regression analyses indicated that receipt of early intervention services was associated with increased parenting stress among mothers of toddlers born very preterm, though number of current medical complications was not. Parents of children born very preterm are at increased risk for parenting stress that extends beyond discharge from the neonatal intensive care unit . Clinicians working in NFU clinics are positioned to monitor for increased parenting stress, particularly among families of children with emerging signs of developmental delay.     

PTSD and the influence of context: The self as a social mirror

The principal accepted models of posttraumatic stress disorder (PTSD) are based on both memory processing and biological/brain changes occurring when one's life or well-being is threatened. It is our thesis that these models would be greatly informed by community studies indicating that PTSD is predicted to a greater extent by earlier life experience and experiences that occur distant from the threatening event. These findings suggest posttraumatic responding is best conceptualized through the lens of the self-in-context, as opposed to imprinting that results from a given event at a given time. Moreover, studies of non-Western populations often do not express trauma as PTSD, or at least not primarily as PTSD, which argues against specific neural or memory encoding processes, but rather for a more plastic neural process that is shaped by experience and how the self develops in its cultural context, as a product of a broad array of experiences. We posit that fear and emotional conditioning as well as the ways traumas are encoded in memory are only partial explanatory mechanisms for trauma responding, and that issues of safety and harm, which are long term and developmental, are the common and principal underpinnings of the occurrence of posttraumatic distress, including PTSD.     

Around the world,adolescence is a time of heightened sensation seeking and immature self‐regulation

The dual systems model of adolescent risk‐taking portrays the period as one characterized by a combination of heightened sensation seeking and still‐maturing self‐regulation, but most tests of this model have been conducted in the United States or Western Europe. In the present study, these propositions are tested in an international sample of more than 5000 individuals between ages 10 and 30 years from 11 countries in Africa, Asia, Europe and the Americas, using a multi‐method test battery that includes both self‐report and performance‐based measures of both constructs. Consistent with the dual systems model, sensation seeking increased between preadolescence and late adolescence, peaked at age 19, and declined thereafter, whereas self‐regulation increased steadily from preadolescence into young adulthood, reaching a plateau between ages 23 and 26. Although there were some variations in the magnitude of the observed age trends, the developmental patterns were largely similar across countries.     

Family conflict is associated with longitudinal changes in insular‐striatal functional connectivity during adolescent risk taking under maternal influence

Maternal presence has marked effects on adolescent neurocognition during risk taking, influencing teenagers to make safer decisions. However, it is currently unknown whether maternal buffering changes over the course of adolescence itself, and whether its effects are robust to individual differences in family relationship quality. In the current longitudinal study, 23 adolescents completed a risk‐taking task under maternal presence during an fMRI scan before and after the transition to high school. Behavioral results reveal that adolescent risk taking increased under maternal presence across a one‐year period. At the neural level, we found that adolescents reporting higher family conflict showed longitudinal increases in functional coupling between the anterior insula (AI) and ventral striatum (VS) when making safe decisions in the presence of their mother, which was associated with increased real‐world risk taking. These findings show that individual differences in family relationship quality undermine effective development of AI‐VS connectivity resulting in increased risk taking.