Initial job analysis of military embedded behavioral health services: Tasks and essential competencies

Utilization of mental health personnel assigned to operational military units is an area of growth for the US military. What activities they perform, how requirements may differ from working in clinical settings, and how to select and train for these types of positions is still poorly understood. A job analysis was conducted of Air Force mental health providers and enlisted technicians embedded in special operations, intelligence, and high-risk training units. Participants rated 27 tasks on frequency, importance, difficulty, and risks, as well as the importance of 37 knowledge, skills, and abilities (KSAs), with differentiation between KSAs that may be trained versus those that must be present to be assigned to the embedded position. Tasks reflected 4 areas of activity: unit embedding/engagement, behavioral health consultation and support, performance optimization activities, and operational mission tasks. Tasks varied by professional training (psychologist, social worker, enlisted technician) and unit type. The KSAs rated as most important were ethical judgment and ability to manage complex relationships and boundaries while working outside of a clinic, strong interpersonal skills with appropriate assertiveness to advocate for safe, effective courses of action, and understanding of unit missions and organizational dynamics. Results have implications for job design, selection criteria, professional disciplines with KSAs necessary to unit-specific tasks, and training of personnel for integrated operational support positions.     

Bocheński on authority

Józef Maria Bocheński introduced an important distinction between deontic and epistemic authority. A typical example of epistemic authority is the relation of a teacher to his students; a typical example of deontic authority is the relation between an employer and his employee. The difference between the two lies in domains of authority: declarative sentences make up the domain in the case of epistemic authority, orders—in the domain of deontic authority. In the article, I analyze in detail the concepts of the two kinds of authority and propose some new explications. The concept of epistemic authority is distinguished from the concept of infallibility and expertise; and the concept of deontic authority is distinguished from the concept of sovereign. I interpret various kinds of deontic authority in the light of the theory of imperative sentences. The concepts of gradation and de-gradation of authority are introduced and explicated.     

Lexicality and Stimulus Length Effects in Italian Dyslexics: Role of the Overadditivity Effect

The effect of lexicality and stimulus length was studied in 32 third- and fourth-grade Italian dyslexics and in 86 age-matched controls. A visual lexical decision task was used. As proposed by Faust et al. (1999) Faust, M. E., Balota, D. A., Spieler, D. H. and Ferraro, F. R. 1999. Individual differences in information-processing rate and amount: Implications for group differences in response latency. Psychological Bulletin, 125: 777–799. [INFOTRIEVE][CROSSREF][CSA][Crossref], [PubMed], [Web of Science ®] , [Google Scholar], the results were analyzed in terms of raw reaction time (RT) data and using the z-score transformation to control for the presence of overadditivity effects. In terms of RTs, dyslexics showed a larger difference between words and nonwords (lexicality effect) and between short and long stimuli (length effect) than proficient readers. When data were transformed into z scores, only the group by length interaction remained significant while that with lexicality vanished. This pattern indicates that stimulus length has a specific role in Italian dyslexics’ reading deficit; in contrast, slowness in responding to nonwords was not specific but was interpreted as one aspect of dyslexics’ general inability to deal with alphabetical material (overadditivity effect).     

Receptive vocabulary and semantic knowledge in children with SLI and children with Down syndrome

Receptive vocabulary and associated semantic knowledge were compared within and between groups of children with specific language impairment (SLI), children with Down syndrome (DS), and typically developing children. To overcome the potential confounding effects of speech or language difficulties on verbal tests of semantic knowledge, a novel task was devised based on picture-based semantic association tests used to assess adult patients with semantic dementia. Receptive vocabulary, measured by word-picture matching, of children with SLI was weak relative to chronological age and to nonverbal mental age but their semantic knowledge, probed across the same lexical items, did not differ significantly from that of vocabulary-matched typically developing children. By contrast, although receptive vocabulary of children with DS was a relative strength compared to nonverbal cognitive abilities (p < .0001), DS was associated with a significant deficit in semantic knowledge (p < .0001) indicative of dissociation between word-picture matching vocabulary and depth of semantic knowledge. Overall, these data challenge the integrity of semantic-conceptual development in DS and imply that contemporary theories of semantic cognition should also seek to incorporate evidence from atypical conceptual development.     

Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity

Conceptually, eating disorder recovery should include physical, behavioral, and psychological components, but such a comprehensive approach has not been consistently employed. Guided by theory and recent recovery research, we identified a “fully recovered” group (n = 20) based on physical (body mass index), behavioral (absence of eating disorder behaviors), and psychological (Eating Disorder Examination-Questionnaire) indices, and compared them with groups of partially recovered (n = 15), active eating disorder (n = 53), and healthy controls (n = 67). The fully recovered group was indistinguishable from controls on all eating disorder-related measures used, while the partially recovered group was less disordered than the active eating disorder group on some measures, but not on body image. Regarding psychosocial functioning, both the fully and partially recovered groups had psychosocial functioning similar to the controls, but there was a pattern of more of the partially recovered group reporting eating disorder aspects interfering with functioning. Regarding other psychopathology, the fully recovered group was no more likely than the controls to experience current Axis I pathology, but they did have elevated rates of current anxiety disorder. Results suggest that a stringent definition of recovery from an eating disorder is meaningful. Clinical implications and future directions regarding defining eating disorder recovery are discussed.     

Predictors of posttraumatic stress in children following injury: The influence of appraisals, heart rate, and morphine use

Prospective studies of posttraumatic stress disorder (PTSD) in children that investigate simultaneously both cognitive and biological or psychophysiological predictors are rare. The present research reports on the impact of cognitive factors (trauma-related appraisals) and biological indicators (heart rate, morphine use) in predicting PTSD and depression symptoms following single-incident trauma. Children and adolescents (N = 48) were assessed within 4 weeks of an injury that led to hospital treatment and followed up 6-months later. While morphine did not predict initial PTSD severity, it was associated with lower levels of PTSD at follow-up. Reductions in PTSD symptoms (change scores) between assessments were similarly associated with morphine dosage. Trauma-related appraisals also contributed to PTSD and depression symptom severity. While slightly different patterns of results were obtained depending on whether static or change scores were examined, as a whole the study adds to a growing literature that morphine has the potential to reduce PTSD symptoms severity. Likewise the relationship between unhelpful trauma appraisals and posttrauma psychopathology was replicated.     

Moderators of continuation phase cognitive therapy's effects on relapse, recurrence, remission, and recovery from depression

About half of patients who respond to acute-phase cognitive therapy (CT) for major depressive disorder (MDD) will relapse/recur within 2 years; continuation-phase CT lowers this risk. We analyzed demographic, clinical, cognitive, social-interpersonal, and personality variables to clarify which patients continuation-phase CT helps to avoid relapse and recurrence and achieve remission and recovery. Participants had recurrent MDD, responded to acute-phase CT, were randomized to 8 months of continuation-phase CT (n = 41) or assessment control (n = 43), and were assessed 16 additional months (Jarrett et al., 2001). Consistent with an underlying risk-reduction model, continuation-phase CT was helpful for responders to acute-phase CT with greater risk and/or dysfunction as follows: Younger patients with earlier MDD onset who displayed greater dysfunctional attitudes and lower self-efficacy; personality traits suggesting low positive activation (e.g., reduced energy, enthusiasm, gregariousness); and transiently elevated depressive symptoms late in acute-phase CT and residual symptoms after acute-phase CT response. We emphasize the need for replication of these results before clinical application.     

Perceived normative pressure and majority adolescents' implicit and explicit attitudes towards immigrants

The aim of the present study was to examine if perceived normative pressure (i.e., perception of the normative expectations of family and friends regarding one's intergroup attitudes) had a direct impact on majority youth's (N = 93) explicit attitudes and moderated the relationship between their implicit (measured with the ST-IAT) and explicit attitudes towards Russian immigrants in Finland. The results indicated that normative pressure is positively associated with the explicit attitudes of adolescents, and that the implicit attitudes of the adolescents towards immigrants surface on the explicit level only when they do not perceive a normative pressure to hold positive intergroup attitudes. More specifically, when there is no normative pressure, the explicit attitudes of youth are, at best, neutral, and reflect their implicit attitudes. In contrast, when normative pressure is perceived to be high, the level of explicit attitudes is generally more positive, and the expression of explicit attitudes is not determined by implicit attitudes. The effects of age, sex, quality of past intergroup contact experiences, and intergroup anxiety were controlled for in the analysis. The findings highlight the importance of taking normative pressure into consideration when studying socially sensitive ethnic attitudes among adolescents.     

Time processing in children with Tourette’s syndrome

Background

Tourette syndrome (TS) is characterized by dysfunctional connectivity between prefrontal cortex and sub-cortical structures, and altered meso-cortical and/or meso-striatal dopamine release. Since time processing is also regulated by fronto-striatal circuits and modulated by dopaminergic transmission, we hypothesized that time processing is abnormal in TS.

Methods

We compared time processing abilities between nine children with TS-only (i.e. without major psychiatric comorbidities) and 10 age-matched healthy children, employing a time reproduction task in which subjects actively reproduce different temporal intervals, and a time comparison task in which subjects judge whether a test interval is longer or shorter than a reference interval. IQ, sustained and divided attention, and working memory were assessed in both groups using the Leiter International Performance Scale-Revised, and the Digit Span sub-test of the WISC-R.

Results

Children with TS-only reproduced in an overestimated fashion over-second, but not sub-second, time intervals. The precision of over-second intervals reproduction correlated with tic severity, in that the lower the tic severity, the closer the reproduction of over-second time intervals to their real duration. Time reproduction performance did not significantly correlate with IQ, attention and working memory measures in both groups. No differences between groups were documented in the time comparison task.

Conclusions

The improvement of time processing in children with TS-only seems specific for the over-second range of intervals, consistent with an enhancement in the ‘cognitively controlled’ timing system, which mainly processes longer duration intervals, and depends upon dysfunctional connectivity between the basal ganglia and the dorso-lateral prefrontal cortex. The absence of between-group differences on time comparison, moreover, suggests that TS patients manifest a selective improvement of ‘motor’ timing abilities, rather than of perceptual time abilities. Our data also support an enhancement of cognitive control processes in TS children, probably facilitated by effortful tic suppression.