Virtual reality goes to war: a brief review of the future of military behavioral healthcare

Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. Virtual Reality delivered exposure therapy for PTSD has been previously used with reports of positive outcomes. This article details how virtual reality applications are being designed and implemented across various points in the military deployment cycle to prevent, identify and treat combat-related PTSD in OIF/OEF Service Members and Veterans. The summarized projects in these areas have been developed at the University of Southern California Institute for Creative Technologies, a U.S. Army University Affiliated Research Center, and this paper will detail efforts to use virtual reality to deliver exposure therapy, assess PTSD and cognitive function and provide stress resilience training prior to deployment.     

A Case of Premature Termination in a Treatment for Generalized Anxiety Disorder

In this paper we present a case of failure in an integrative treatment for generalized anxiety disorder (GAD) combining cognitive-behavioral therapy, an empirically supported treatment for GAD, and interpersonal-emotional processing therapy. The client of focus dropped out of treatment after the eighth session. Based on our analysis of this case, we discuss the participant, technical and relationship factors that were likely implicated in this case of premature termination in both of the cognitive-behavioral and interpersonal-emotional processing segments that comprised the treatment. Implications for practice, training and future research are also discussed.     

Context fear learning specifically activates distinct populations of neurons in amygdala and hypothalamus

The identity and distribution of neurons that are involved in any learning or memory event is not known. In previous studies, we identified a discrete population of neurons in the lateral amygdala that show learning-specific activation of a c-fos-regulated transgene following context fear conditioning. Here, we have extended these studies to look throughout the amygdala for learning-specific activation. We identified two further neuronal populations, in the amygdalo-striatal transition area and medial amygdala, that show learning-specific activation. We also identified a population of hypothalamic neurons that show strong learning-specific activation. In addition, we asked whether these neurons are activated following recall of fear-conditioning memory. None of the populations of neurons we identified showed significant memory-recall-related activation. These findings suggest that a series of discrete populations of neurons are involved in fear learning in amygdala and hypothalamus. The lack of reactivation during memory recall suggests that these neurons either do not undergo substantial change following recall, or that c-fos is not involved in any such activation and change.     

Behavioral versus Behavioral and Pharmacological Treatment in ADHD Children Attending a Summer Treatment Program

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed.     

Left-hemisphere activation and deficient response modulation in psychopaths

Psychopathic offenders have difficulty processing contextual or secondary cues once they have initiated goal-directed behavior or allocated attention to a primary task. To test the hypothesis that this deficit in response modulation is specific to conditions in which psychopaths' left-hemisphere resources are engaged, we administered a serial recall task to 21 incarcerated psychopaths and 21 control subjects. Subjects were instructed to memorize eight words that were presented one at a time, each in one of the four corners of the visual display. Subjects' primary task was to recall the words in serial order. Then, without forewarning, they were asked to recall the words' locations. As predicted, psychopaths performed as well as control subjects in recalling words from the left and right spatial fields, but recalled significantly fewer locations from the right spatial field. Thus, psychopaths' deficient response modulation was specific to conditions in which their left-hemisphere resources were actively engaged.     

The constituent structure of autobiographical memory: autobiographical fluency in people with chronic epilepsy

A total of 59 people with chronic epilepsy recalled autobiographical episodes and personal facts (such as the names of friends or teachers) from various lifetime periods. Also tested was their verbal fluency and their fluency in generating items from semantic categories (animals, vegetables, US presidents, and British prime ministers). Results of a cluster analysis and a common factor analysis confirmed a dissociation between the retrieval of autobiographical information and that of nonpersonal semantic information. There was a similar dissociation between the recall of personal episodes and the recall of the personal information, but the corresponding factors were highly correlated with one another. Finally, verbal fluency performance was significantly correlated with the retrieval of personal information, personal episodes, and common objects, but not with that of public figures. The constituent structure of autobiographical fluency is extremely robust across different populations.     

A formal cognitive model of the go/no-go discrimination task: evaluation and implications

This article proposes and tests a formal cognitive model for the go/no-go discrimination task. In this task, the performer chooses whether to respond to stimuli and receives rewards for responding to certain stimuli and punishments for responding to others. Three cognitive models were evaluated on the basis of data from a longitudinal study involving 400 adolescents. The results show that a cue-dependent model presupposing that participants can differentiate between cues was the most accurate and parsimonious. This model has 3 parameters denoting the relative impact of rewards and punishments on evaluations, the rate that contingent payoffs are learned, and the consistency between learning and responding. Commission errors were associated with increased attention to rewards; omission errors were associated with increased attention to punishments. Both error types were associated with low choice consistency. The parameters were also shown to have external validity: Attention to rewards was associated with externalizing behavior problems on the Achenbach scale, and choice consistency was associated with low Welsh anxiety. The present model can thus potentially improve the sensitivity of the task to differences between clinical populations.     

The reliability and validity of the panic disorder self-report: a new diagnostic screening measure of panic disorder

This study examined the Panic Disorder Self-Report (PDSR), a new self-report diagnostic measure of panic disorder based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994). PDSR diagnoses were compared with structured interview diagnoses of individuals with generalized anxiety disorder, social phobia, and panic disorder and nonanxious controls. Receiver operating characteristic analyses revealed that the PDSR showed 100% specificity and 89% sensitivity. The PDSR also demonstrated retest reliability, convergent and discriminant validity, and kappa agreement of .93 with a structured interview. Finally, the PDSR demonstrated clinical validity. Students who were identified as having panic disorder using the PDSR did not have significantly different scores on the Panic Disorder Severity Scale--Self-Report form (P. R. Houck, D. A. Speigel, M. K. Shear, & P. Rucci, 2002) than a panic disordered community sample. However, both groups had significantly higher scores than students identified as not meeting criteria for panic disorder.     

Preferences for involvement in medical decision making: comparing British and German views

Despite beneficial outcomes of patients' involvement in medical decision processes, it has been claimed that patients are generally not interested in medical decision making (MDM). Whereas current research focuses on actual MDM, this research explored the impact of nationality and perceptual processes of MDM. Preferences for involvement in decision making were examined in a sample of 204 German and 143 British university students. Hierarchical multiple regressions were employed to explore the link between socio-demographic information, individuals' perceived relationship with their GP, Health Locus of Control - Powerful Others, perceptions regarding the frequency and sufficiency of information provision and involvement in MDM, and individuals' preferred level of involvement and information. A significant amount of the variance in individuals preferences for involvement could be explained (Adjusted R2 = .59, p < .001). Independent t-test analyses showed that British and German perceptions of care differed significantly on a variety of different measures. Separate analyses for the German and British group highlighted cross-national differences in care and preferences for involvement. The study suggests that preferences to become involved might depend more on perceptual processes than actual involvement in decision making, and that communication and national health policy could play an important role.