Predicting Treatment Outcomes From Internet-Based Cognitive Behavior Therapy for Obsessive–Compulsive Disorder

Internet-based cognitive-behavioral therapy (ICBT) with therapist support shows promise as a treatment for obsessive-compulsive disorder (OCD). Yet, not all patients respond to ICBT. It is therefore important to identify predictors of ICBT outcomes to determine who is likely to benefit. Relative to the large literature on predictors of outcomes for in-person CBT for OCD, very few studies have investigated ICBT predictors. Therefore, we analyzed predictors of outcome in an open trial (n = 30) of ICBT for OCD using the OCD-NET platform, which consists of 10 online modules delivered with therapist support. The Yale-Brown Obsessive-Compulsive Scale (YBOCS) was administered by independent raters as the primary outcome measure at baseline and posttreatment. In this sample, greater baseline OCD severity and OCD-related avoidance behaviors were associated with higher end-state OCD symptoms (i.e., poorer outcome). Patients with a past history of face-to-face CBT for OCD also had worse outcomes. Although these results require replication, these factors may identify individuals at risk for poor ICBT outcomes.     

Impact of End-of-Life Circumstances on the Adjustment of Bereaved Siblings of Children Who Died from Cancer

The aim of this study was to examine the impact of end-of-life (EoL) circumstances on grief and internalizing symptoms among bereaved siblings. Bereaved families (N?=?88) were recruited from three sites 3–12 months (M?=?11.57, SD?=?3.48) after their child’s death from cancer. One sibling per family aged 8–17 years (M?=?12.41, SD?=?2.64) was randomly selected to participate. Families completed measures of siblings’ grief and internalizing symptoms, as well as a structured interview about circumstances surrounding the death. Mother and sibling reports of EoL circumstances were generally concordant, except there was a discrepancy between mothers and children about whether or not children expected their sibling’s death (t(75)?=?1.52, p?=?.018). Mother reports of sibling internalizing symptoms were above the normative mean (t(83)?=?4.44, p?≤?.001 (M?=?56.01?±?12.48), with 39% (n?=?33) in the borderline/clinical range. Sibling opportunity to say goodbye was associated with greater grief-related growth (t(79)?=?? 1.95, p?=?.05). Presence at the death and wishing they had done something differently were both associated with greater grief (t(80)?=?? 2.08, p?=?.04 and t(80)?=?? 2.24, p?=?.028, respectively) and grief-related growth (t(80)?=?? 2.01, p?=?.048 and t(80)?=?? 2.31, p?=?.024, respectively). However, findings were primarily unique to sibling report, with few mother-reported effects. The adjustment of bereaved siblings may be affected by certain modifiable circumstances surrounding the death of their brother or sister. A proportion of bereaved siblings had elevated internalizing symptoms irrespective of circumstances at EoL. Further work is needed to understand predictors of adjustment among bereaved siblings to provide better support and optimize their outcomes.

     

Intelligence: new findings and theoretical developments

We review new findings and new theoretical developments in the field of intelligence. New findings include the following: (a) Heritability of IQ varies significantly by social class. (b) Almost no genetic polymorphisms have been discovered that are consistently associated with variation in IQ in the normal range. (c) Much has been learned about the biological underpinnings of intelligence. (d) "Crystallized" and "fluid" IQ are quite different aspects of intelligence at both the behavioral and biological levels. (e) The importance of the environment for IQ is established by the 12-point to 18-point increase in IQ when children are adopted from working-class to middle-class homes. (f) Even when improvements in IQ produced by the most effective early childhood interventions fail to persist, there can be very marked effects on academic achievement and life outcomes. (g) In most developed countries studied, gains on IQ tests have continued, and they are beginning in the developing world. (h) Sex differences in aspects of intelligence are due partly to identifiable biological factors and partly to socialization factors. (i) The IQ gap between Blacks and Whites has been reduced by 0.33 SD in recent years. We report theorizing concerning (a) the relationship between working memory and intelligence, (b) the apparent contradiction between strong heritability effects on IQ and strong secular effects on IQ, (c) whether a general intelligence factor could arise from initially largely independent cognitive skills, (d) the relation between self-regulation and cognitive skills, and (e) the effects of stress on intelligence.     

Individual development and evolution: experiential canalization of self-regulation

In this article, we contrast evolutionary and psychobiological models of individual development to address the idea that individual development occurring in prototypically risky and unsupportive environments can be understood as adaptation. We question traditional evolutionary explanations of individual development, calling on the principle of probabilistic epigenesis to suggest that individual development resulting from the combined activity of genes and environments is best understood to precede rather than follow from evolutionary change. Specifically, we focus on the ways in which experience shapes the development of stress response physiology, with implications for individual development and intergenerational transmission of reactive, as opposed to reflective, phenotypes. In doing so, we describe results from several analyses conducted with a longitudinal data set of 1,292 children and their primary caregivers followed from birth. Our results indicate that the effects of poverty on stress response physiology and on the development of the self-regulation of behavior represent instances of the experiential canalization of development with implications for understanding the genesis and "adaptiveness" of risk behavior.     

Executive function in early childhood: longitudinal measurement invariance and developmental change

This study tested the longitudinal measurement invariance and developmental changes of a newly developed battery of executive function (EF) tasks for use in early childhood. The battery was administered in the Family Life Project-a prospective longitudinal study (N = 1,292) of families who were oversampled from low-income and African American families at the birth of a new child-at assessments conducted when the child was 3, 4, and 5 years old. All 6 individual EF tasks exhibited strong measurement invariance over time. The EF battery, which was derived from the 6 individual tasks, exhibited partial strong invariance over time. Second-order latent growth curve models revealed individual differences in the levels but not rates of change in latent EF ability. The functional form of change was nonlinear; 60% of the total change in EF ability that was observed between the 3- and 5-year assessments occurred between the Year 3 and Year 4 assessments. Results are discussed with respect to the importance of establishing scalable measures of EF ability prior to investigating experiences that predict or are predicted by changes in EF during early childhood.     

False external feedback modulates posterror slowing and the f-P300: implications for theories of posterror adjustment

People tend to slow down after mistakes. This posterror slowing (PES) has commonly been explained by a change to a more conservative response threshold to avoid future errors. Alternatively, the attention-orienting account posits that all infrequent, surprising events (including errors) elicit an orienting response followed by a time-consuming process of task reorientation, explaining PES without increased response caution. In the present study, we employed both behavioral and electrophysiological measures to compare the predictions of these accounts using a flanker paradigm in which accurate or false external response feedback was provided. Participants demonstrated typical posterror adjustments, responding more slowly and accurately in posterror than in postcorrect trials. This finding provides initial evidence suggesting that posterror adjustments are motivated by the avoidance of subsequent mistakes. Most importantly, PES and an event-related potential relating to the attentional processing of feedback, the feedback-related P300 (f-P300), were modulated by feedback type. More specifically, the f-P300 was larger after false than after accurate feedback, suggesting that participants oriented their attention toward (i.e., were surprised by) inaccurate feedback signals. Interestingly, false feedback differentially modulated reaction times: Participants were slower after correct responses when feedback falsely informed of an error rather than confirmed the correct response. In contrast, faster responses were made after errors when feedback falsely indicated correct rather than incorrect performance. When these patterns of results are regarded together, they are best explained by theories of cognitive control in which posterror adjustments in choice reaction time tasks are assumed to reflect control processes leading to more conservative performance after error signals.     

Family Systems and Ecological Perspectives on the Impact of Deployment on Military Families

The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent–child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.     

The test–retest reliability of the latent construct of executive function depends on whether tasks are represented as formative or reflective indicators

This study investigates the test–retest reliability of a battery of executive function (EF) tasks with a specific interest in testing whether the method that is used to create a battery-wide score would result in differences in the apparent test–retest reliability of children’s performance. A total of 188 4-year-olds completed a battery of computerized EF tasks twice across a period of approximately two weeks. Two different approaches were used to create a score that indexed children’s overall performance on the battery—i.e., (1) the mean score of all completed tasks and (2) a factor score estimate which used confirmatory factor analysis (CFA). Pearson and intra-class correlations were used to investigate the test–retest reliability of individual EF tasks, as well as an overall battery score. Consistent with previous studies, the test–retest reliability of individual tasks was modest (rs ≈ .60). The test–retest reliability of the overall battery scores differed depending on the scoring approach (r_mean = .72; r_{factor_score} = .99). It is concluded that the children’s performance on individual EF tasks exhibit modest levels of test–retest reliability. This underscores the importance of administering multiple tasks and aggregating performance across these tasks in order to improve precision of measurement. However, the specific strategy that is used has a large impact on the apparent test–retest reliability of the overall score. These results replicate our earlier findings and provide additional cautionary evidence against the routine use of factor analytic approaches for representing individual performance across a battery of EF tasks.