Behavioral Health Interventions Being Implemented in a VA Primary Care System

The integration of behavioral health and primary care has received much attention in the literature. Behavioral health providers (BHPs) in integrated settings are faced with different treatment constraints than those who work in specialty mental health. The existing literature focuses on what BHPs should do in primary care settings; however, little research exists specifying what BHPs are actually doing. This study provides a glimpse into what types of interventions BHPs are using, and what types of patients they are seeing, in primary care. A chart review was conducted of patients (N?=?180) seen by BHPs in five Veterans Affairs primary care clinics. Depression was the most common diagnosis, while less common presenting problems included substance abuse/dependence, psychosis, and bipolar disorder. Common interventions used were medical management, psycho-education, elements of cognitive-behavioral therapy (CBT), and supportive psychotherapy. Future research should examine the efficacy of brief interventions in primary care settings.     

(Mis)perception of sleep in insomnia: a puzzle and a resolution

Insomnia is prevalent, causing severe distress and impairment. This review focuses on illuminating the puzzling finding that many insomnia patients misperceive their sleep. They overestimate their sleep onset latency (SOL) and underestimate their total sleep time (TST), relative to objective measures. This tendency is ubiquitous (although not universal). Resolving this puzzle has clinical, theoretical, and public health importance. There are implications for assessment, definition, and treatment. Moreover, solving the puzzle creates an opportunity for real-world applications of theories from clinical, perceptual, and social psychology as well as neuroscience. Herein we evaluate 13 possible resolutions to the puzzle. Specifically, we consider the possible contribution, to misperception, of (1) features inherent to the context of sleep (e.g., darkness); (2) the definition of sleep onset, which may lack sensitivity for insomnia patients; (3) insomnia being an exaggerated sleep complaint; (4) psychological distress causing magnification; (5) a deficit in time estimation ability; (6) sleep being misperceived as wake; (7) worry and selective attention toward sleep-related threats; (8) a memory bias influenced by current symptoms and emotions, a confirmation bias/belief bias, or a recall bias linked to the intensity/recency of symptoms; (9) heightened physiological arousal; (10) elevated cortical arousal; (11) the presence of brief awakenings; (12) a fault in neuronal circuitry; and (13) there being 2 insomnia subtypes (one with and one without misperception). The best supported resolutions were misperception of sleep as wake, worry, and brief awakenings. A deficit in time estimation ability was not supported. We conclude by proposing several integrative solutions.     

Cognitive biases and obsessive-compulsive symptoms in children: examining the role of maternal cognitive bias and child age

Objective: Multiple cognitive biases associated with adult obsessive-compulsive disorder (OCD) were tested in a clinical sample of children (ages 7-11) and adolescents (12-17) and their mothers. This study examined (a) the associations between child cognitive biases and OCD severity, (b) maternal cognitive biases and child OCD severity, and (c) maternal cognitive bias and child cognitive bias. It was hypothesized that age would significantly moderate these relationships, with stronger associations with OCD severity for cognitive bias in adolescents (relative to children), and maternal cognitive bias in younger children (relative to adolescents). Method: Forty-six children and adolescents diagnosed with OCD and their mothers completed questionnaires assessing responsibility bias, thought-action fusion (TAF), thought suppression, and metacognitive beliefs. OCD symptoms were assessed using structured diagnostic interviews and semistructured symptom interviews. Results: As predicted, age significantly moderated associations between (a) child cognitive variables and OCD severity-specifically between child responsibility and child metacognition, which were associated with OCD severity for adolescents only; (b) maternal cognitive biases and child OCD severity-specifically for maternal responsibility and thought suppression, which were significantly and positively associated with child OCD severity but not adolescent OCD severity; and (c) maternal cognitive biases and child cognitive bias-such that significant associations were evident only in the younger child sample, and only between maternal TAF self and metacognition, with child suppression and child TAF moral, respectively. Conclusion: Maternal cognitive biases are more consistently linked to greater OCD severity among younger children, whereas personal cognitive biases are associated with greater OCD symptoms in adolescents. Treatments for pediatric OCD are likely to be improved by age-specific considerations for the role of maternal and child cognitive biases associated with OCD.     

Incremental Benefits of a Daily Report Card Intervention Over Time for Youth With Disruptive Behavior

This study examined the percentage of children who respond positively to a daily report card (DRC) intervention and the extent to which students achieve incremental benefits with each month of intervention in a general education classroom. Participants were 66 children (87% male) with attention-deficit hyperactivity disorder or disruptive behavior problems who were enrolled in a school-based intervention program in rural, low-income school districts in a Midwest state. The DRC was implemented by each child's teacher, who received consultation from a graduate student clinician, school district counselor, or school district social worker. A latent class analysis using growth-mixture modeling identified two classes of response patterns (i.e., significant improvement and significant decline). Results indicated that 72% of the sample had all of their target behaviors classified as improved, 8% had all of their targets classified as declining, and 20% had one target behavior in each class. To examine the monthly incremental benefit of the DRC, individual effect sizes were calculated. Results for the overall sample indicated that most children experience a benefit of large magnitude (.78) within the first month, with continued incremental benefits through Month 4. The differential pattern of effect sizes for the group of improvers and the group of decliners offer data to determine when and if the DRC should be discontinued and an alternative strategy attempted. Evidence-based guidelines for practical implementation of the DRC are discussed.     

Evidence of rapid recovery from perceptual odor adaptation using a new stimulus paradigm

By attenuating neural and perceptual responses to sustained stimulation, adaptation enhances the detection of new, transient stimuli. Disadaptation serves a similarly important role as a temporal filter for chemoreceptor cells, producing rapid recovery of sensitivity upon termination of the adapting odorant. Previous research from our laboratory indicated that a rapid form of odor adaptation can be measured using a novel, simultaneous-odorant paradigm. In the present study, we extended the earlier method by measuring recovery from adaptation. Perceptual odor adaptation was measured by estimating psychophysical detection thresholds in a group of college-aged student volunteers (N = 20; 12 females, eight males) for a self-adapting odorant, vanilla extract. To induce adaptation, the time between the onset of the adapting odorant and the onset of the target odorant was systematically varied. By first quantifying adaptation, recovery of sensitivity could therefore be investigated by using different time points following the termination of the adapting odorant. Consistent with our previous work, thresholds estimated in the presence of the simultaneous adapting odorant were significantly increased, reflecting a decrease in sensitivity due to adaptation. Conversely, approximately 100 ms following termination of the adapting stimulus (the briefest delay tested), sensitivity began to rapidly recover. Nevertheless, some residual adaptation was evident at the longest offset delay of 500 ms. These findings suggest that the recovery from adaptation proceeds at least as rapidly as the onset of adaptation, a finding that is consistent with physiological evidence from olfactory receptors. These data also suggest the effectiveness of this new odorant paradigm in characterizing the temporal characteristics underlying these critical olfactory mechanisms.     

Visual context modulates potentiation of grasp types during semantic object categorization

Substantial evidence suggests that conceptual processing of manipulable objects is associated with potentiation of action. Such data have been viewed as evidence that objects are recognized via access to action features. Many objects, however, are associated with multiple actions. For example, a kitchen timer may be clenched with a power grip to move it but pinched with a precision grip to use it. The present study tested the hypothesis that action evocation during conceptual object processing is responsive to the visual scene in which objects are presented. Twenty-five healthy adults were asked to categorize object pictures presented in different naturalistic visual contexts that evoke either move- or use-related actions. Categorization judgments (natural vs. artifact) were performed by executing a move- or use-related action (clench vs. pinch) on a response device, and response times were assessed as a function of contextual congruence. Although the actions performed were irrelevant to the categorization judgment, responses were significantly faster when actions were compatible with the visual context. This compatibility effect was largely driven by faster pinch responses when objects were presented in use-compatible, as compared with move-compatible, contexts. The present study is the first to highlight the influence of visual scene on stimulus–response compatibility effects during semantic object processing. These data support the hypothesis that action evocation during conceptual object processing is biased toward context-relevant actions.     

Grammatical context constrains lexical competition in spoken word recognition

When perceiving spoken language, listeners must match the incoming acoustic phonetic input to lexical representations in memory. Models that quantify this process propose that the input activates multiple lexical representations in parallel and that these activated representations compete for recognition (Weber & Scharenborg, 2012). In two experiments, we assessed how grammatically constraining contexts alter the process of lexical competition. The results suggest that grammatical context constrains the lexical candidates that are activated to grammatically appropriate competitors. Stimulus words with little competition from items of the same grammatical class benefit more from the addition of grammatical context than do words with more within-class competition. The results provide evidence that top-down contextual information is integrated in the early stages of word recognition. We propose adding a grammatical class level of analysis to existing models of word recognition to account for these findings.     

The effect of prenatal androgen exposure on the development of neural reactivity systems: A study of the HEXACO Personality Inventory

The ratio of the lengths of the second and fourth digits of hands (2D:4D) seems to vary as a function of systematic differences in prenatal androgen exposure (Hönekopp & Watson, 2010). The 2D:4D ratio has been shown to be related to a variety of personality attributes. This study predicted that 2D:4D would covary with scores on the emotionality dimension of the six-facet HEXACO personality assessment, due to emotionality’s relationship with neural reactivity systems controlled by the amygdala (Hines, Allen, & Gorski, 1992), but that 2D:4D would relate to no other facet. Consistent with hypotheses, data showed that men had smaller ratios than women on both the right, t(405) = 2.84, p < .05, d = .28, and left hands, t(405) = 4.51, p < .05, d = .45, and the relationship between 2D:4D and emotionality was outside of sampling error of zero, r = .18, p < .001. Additionally, 2D:4D was unrelated to the remaining HEXACO facets. Findings suggest that prenatal testosterone exposure has an organizing effect on personality traits.     

Primary Trauma of Female Partners in a Military Sample: Individual Symptoms and Relationship Satisfaction

Research traditionally has focused on the development of symptoms in those who experienced war trauma directly but overlooked the impact of trauma in the partners of soldiers. The current study reports data from 45 couples where the male partners were Army soldiers who recently returned from deployments to Iraq (Operation Iraqi Freedom) or Afghanistan (Operation Enduring Freedom). Results from this study indicated that female partner primary trauma, particularly trauma related to PTSD re-experiencing and arousal symptoms, has an influence on levels of relationship satisfaction, both for female partners and soldiers.