Efficacy of telephone-administered cognitive behaviour therapy for obsessive-compulsive spectrum disorders: case studies

Cognitive behaviour therapy is effective for obsessive-compulsive disorder and for obsessive-compulsive spectrum disorders such as trichotillomania. Unfortunately, many people with these disorders, especially those living in rural areas, have limited access to treatment. Telephone-administered cognitive behaviour therapy may help address this problem. In a recent study of telephone treatment for obsessive-compulsive disorder, we found that such treatment was often effective (42% in remission at post-treatment, and 47% in remission at 12-week follow-up). This article presents 2 case reports of the same treatment, applied to obsessive-compulsive spectrum disorders (trichotillomania and compulsive skin picking). Treatment was associated with symptom reduction for both participants, although one subsequently relapsed. Possible reasons for relapse are discussed. The findings encourage further studies to identify the characteristics of people most likely to benefit from telephone treatment for spectrum disorders.     

The case for sensorimotor coding in working memory

The highly influential Baddeley and Hitch model of working memory (Baddeley & Hitch, 1974; see also Baddeley, 1986) posited analogical forms of representation that can be broadly characterized as sensorimotor, both for verbal and for visuospatial material. However, difficulties with the model of verbal working memory in particular have led investigators to develop alternative models that avoid appealing either to sensory coding or to motoric coding, or to both. This paper examines the evidence for sensorimotor coding in working memory, including evidence from neuropsychology and from sign language research, as well as from standard working memory paradigms, and concludes that only a sensorimotor model can accommodate the broad range of effects that characterize verbal working memory. In addition, several findings that have been considered to speak against sensorimotor involvement are reexamined and are argued to be in fact compatible with sensorimotor coding. These conclusions have broad implications, in that they support the emerging theoretical viewpoint of embodied cognition.     

Abnormalities of motor and praxis imagery in children with DCD

In an earlier study using the visually guided pointing task (VGPT) the authors showed that the timing of imagined movement sequences in children with developmental coordination disorder (DCD) does not conform to the conventional speed-for-accuracy trade-off (or Fitts' law [P.M. Fitts, Journal of Experimental Psychology 47 (1954) 381-391]) that occurs when the distance and accuracy requirements of movements are varied [P. Maruff, P.H. Wilson, M. Trebilcock, J. Currie, Neuropsychologia 37 (1999b) 1317-1324]. The present study sought to replicate this earlier finding and to examine (using a weight manipulation) whether this deficit was also attributable to inaccurate programming of relative force. The chronometry of real and imagined movements was investigated in a group of 20 children with DCD aged between 8 and 12 years and a group of controls matched on age and verbal IQ (VIQ). Movement duration was tested for real and imagined movements using the preferred hand, with the VGPT performed under two load conditions: with and without the addition of a weight attached to a pen. Group means of each subjects' mean movement duration were calculated and plotted against target width for each of the four conditions [Movement type (2) x Load (2)] and a logarithmic curve was fitted to the data points. In the control group, the speed-for-accuracy trade-off for both real and imagined performance conformed to Fitts' law under each load condition. In the DCD group only real movements conformed to Fitts' law. Moreover, the effect of load differed between groups--for real movements, movement duration did not differ between load and no-load conditions for either group, while for imagined movements, movement duration increased under the load condition for the control group only. These results replicate and extend the results of our earlier study. This pattern of performance suggests that children with DCD have an impairment in the ability to generate internal representations of volitional movements which may reflect an impaired ability to process efference copy signals. The ability to programme both relative force and timing appears to underly this difficulty. Results have implications for the use of (guided) motor imagery training in order to facilitate the development of motor skill in children with DCD.     

Stressful life events and impulsiveness in failed suicide

The relationship of recent stressful life events with impulsiveness in triggering suicide attempts and how impulsiveness changes from one suicide attempt to another is unclear. This study used structured-interview tools and standardized measurements to examine the relationship between life stress and impulsiveness in a sample of patients who required hospitalization for a medically serious suicide attempt. After controlling for potentially confounding variables, the number of disrupted interpersonal relationships in the preceding year was a significant predictor of the impulsiveness of the suicide attempt, with three or more losses (but not other life stresses) associated with less impulsive attempts (T = 2.4, p = .02). Female gender (T = -1.98, p = .05) and lifetime DMS-III-R diagnoses (T = -2.45, p = .02) were significantly associated with more impulsive attempts. In 55 patients with at least two suicide attempts, impulsiveness, lethal intent, and communication of intent were significantly greater for the present compared to the prior attempt (p = 0.000). Certain stressful life events, gender, and total lifetime DSM-III-R diagnoses are associated with impulsiveness of failed suicide attempts; yet, impulsiveness is not necessarily consistent from one suicide attempt to another. This evidence supports and amplifies a stress-diathesis model of suicide behavior. Accordingly, efforts to increase personal resilience in individuals who have "failed suicide" may be more effective at preventing suicide morbidity than simple stress-reduction measures alone.     

Attachment disorders: review and current status

Developmental research on attachment has flourished in the past 15 years (C. H. Zeanah, 1996). However, there has been relatively scant empirical investigation of disorders in attachment. In this article, the pertinent developmental research on the attachment cycle is delineated and the current status of disordered attachment is examined. A particular focus is given to the conceptualization of the most severe form of disordered attachment, Reactive Attachment Disorder.     

Attitudes toward parenting strategies, potential for child abuse, and parental satisfaction of ethnically diverse low-income U.S. mothers

Among a sample of 176 low-income mothers from 3 ethnic groups in the United States, the authors investigated ethnic differences in attitudes toward preferred parenting strategies, or styles; ethnic differences in the potential for child abuse; and the relationship between parenting strategies, the potential for child abuse, and parental satisfaction. They distributed the Maternal Reactions to Child's Deviant Behavior subscale (K. M. Rickard, W. Graziano, & R. Forehand, 1984), a shortened version of the Child Abuse Potential Inventory (CAPI; J. S. Milner & R. C. Wimberley, 1979), and a Parental Satisfaction Scale (N. P Medora, S. M. Wilson, & J. Larson, 1996) to the participants. The results indicated no significant ethnic differences in preferred parenting styles. Mothers from all 3 ethnic groups ranked praise and reasoning as the 1st and 2nd preferred parenting strategies. There were no ethnic differences in the perceived potential for child abuse. Parental satisfaction was negatively related to 2 of the CAPI subscales--Loneliness and Problems. The parenting strategy reasoning was positively correlated with parental satisfaction.     

Performance of Dyslexic Children on Cerebellar and Cognitive Tests

In a previous study (A. J. Fawcett, R. I. Nicolson, & P. Dean, 1996), the authors had found strong behavioral evidence for cerebellar deficit in a panel of children with dyslexia. In the present study, the generality of those results was assessed. A battery of clinical tests for cerebellar dysfunction was administered, together with selected cognitive tests, to a further 59 dyslexic and 67 control children. The dyslexic children showed highly significant impairments on the cerebellar tests, with deficits on postural stability and muscle tone comparable in magnitude with their reading and spelling deficits. Furthermore, over 95&percent; of the dyslexic children showed clear evidence of deficit on muscle tone or stability. The findings provide further evidence of the generality of cerebellar impairment in dyslexia. The implications of the cerebellar tests for screening in dyslexia are discussed.     

"I" Value Freedom, But "We" Value Relationships: Self-Construal Priming Mirrors Cultural Differences in Judgment

The distinction between relatively independent versus interdependent self-construals has been strongly associated with several important cultural differences in social behavior. The current studies examined the causal role of self-construal by investigating whether priming independent or interdependent self-construals within a culture could result in differences in psychological worldview that mirror those traditionally found between cultures. In Experiment 1, European-American participants primed with interdependence displayed shifts toward more collectivist social values and judgments that were mediated by corresponding shifts in self-construal. In Experiment 2, this effect was extended by priming students from the United States and Hong Kong with primes that were consistent and inconsistent with their predominant cultural worldview. Students who received the inconsistent primes were more strongly affected than those who received the consistent primes, and thus shifted self-construal, and corresponding values, to a greater degree.     

Adolescent substance use disorders: findings from a 14-year follow-up of speech/language-impaired and control children.

Intervening on the development of adolescent addiction requires an understanding of the role of precursors. In a community sample of youth with and without early childhood speech/language (S/L) impairments, 12.7% of participants had a substance use disorder (SUD). Among these participants, 42.0% met criteria for more than 1 SUD. Interestingly, rates of SUDs did not differ by S/L status. However, S/L-impaired participants did show greater psychiatric comorbidity and poorer functioning. A total of 80% of S/L participants with SUDs had a concurrent diagnosis of antisocial personality disorder, compared with 43.8% of SUDs controls. In a logistic regression analysis, we found age 5 mother-rated problem behavior scores and an interaction between S/L status and teacher-rated conduct problem scores were predictive of SUDs. High conduct scores were predictive of SUDs development among control participants but not among S/L-impaired participants. First substance use and initial SUDs symptoms suggest that a window of opportunity exists to reach these troubled young people before they spiral into addiction.     

Shades of the mirror effect: Recognition of faces with and without sunglasses

A mirror effect was found for a stimulus manipulation introduced at test. When subjects studied a set of normal faces and then were tested with new and old faces that were normal or wearing sunglasses, the hit rate was higher and the false alarm rate was lower for normal faces. Hit rate differences were reflected in remember and sure recognition responses, whereas differences in false alarm rates were largely seen in know and unsure judgments. In contrast, when subjects studied faces wearing sunglasses, the hit rate was greater for test faces with sunglasses than for normal faces, but there was no difference in false alarm rates. These findings are problematic for single-factor theories of the mirror effect, but can be accommodated within a two-factor account.