Cognitive-behavioural interventions in a patient with an anxiety disorder related to diabetes

This study extends the data on the efficacy of cognitive interventions for patients with chronic medical problems and describes the case of a 37-year-old woman with an anxiety disorder related to diabetes. The effects on panic frequency, use of safety behaviour and related beliefs were investigated after the introduction of two main cognitive-behavioral interventions. The results are consistent with predictions from the cognitive model of panic. This case demonstrates the usefulness of directly challenging the 'meaning' of the feared situation in order to produce clinically significant improvements in the management of physical disease.     

EFFECTS OF PREFERENCE AND REINFORCER VARIATION ON WITHIN-SESSION PATTERNS OF RESPONDING

We examined correspondence between preference assessment outcome and within‐session patterns of responding in one subject with autism. Responding maintained by a single highly preferred item resulted in a greater total number of responses, a slower decline in within‐session response rates, and a greater proportion of short interresponse times compared to responding maintained by varied moderately preferred (MP) stimuli. Presenting varied MP stimuli within the same session produced greater levels and more sustained responding than presenting those same stimuli individually.     

Self-reported experience of bullying of students who stutter: relations with life satisfaction, life orientation, and self-esteem

Self-reported self-esteem, life orientation, satisfaction with life, and bullying were examined in relation to victimization experiences among 54 students who stuttered and 54 students who did not stutter. Those who stuttered reported greater, i.e., clinically significant, victimization (44.4%) than students who did not stutter (9.2%). Significant differences were found between means for self-esteem and life orientation, with students who stuttered reporting lower self-esteem and less optimistic life orientation than those who did not stutter. In both groups of students, high victimization scores had statistically significant negative correlations with optimistic life orientation, high self-esteem, and high satisfaction with life scores. Given the increased likelihood of students who stuttered being bullied, the negative relation of adjustment variables and bullying, and the potentially negative long-term effects of bullying, increased vigilance and early intervention are discussed.     

Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration

Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) entails regular intravitreal anti-vascular endothelial growth factor (VEGF) injections, often indefinitely. Little is known about the burden imposed on patients by this repetitive treatment schedule and how this can be best managed. The aim of this study was to explore the psychosocial impact of repeated intravitreal injections on patients with neovascular AMD. Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited using purposive sampling from a private ophthalmology practice and public hospital in Melbourne. Patients were surveyed using the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ; Bradley, Health Psychology Research Unit, Surrey, England) and underwent semi-structured, one-on-one interviews. Interview topics were: treatment burden and satisfaction; tolerability; barriers to adherence; treatment motivation; and patient education. Interviews were audio recorded and thematic analysis performed using NVivo 10 (QSR International, Doncaster, Australia). Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule. Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers. Many patients were restricted to sedentary activities post-injection owing to treatment side effects. Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received. Whilst anti-VEGF injections represent the current mainstay of treatment for neovascular AMD, the ongoing treatment protocol imposes significant burden on patients. An understanding of the factors that contribute to the burden of treatment may help inform strategies to lessen its impact and assist patients to better manage the challenges of treatment.     

Functional communication training and noncontingent reinforcement in treatment of stereotypy

A 6‐year‐old boy with autism spectrum disorder engaged in automatically maintained stereotypy in the form of opening and closing doors. A functional analysis confirmed that he also emitted problem behavior that was maintained by access to stereotypy. We evaluated the separate and combined effects of functional communication training and arbitrary noncontingent reinforcement on both response classes. Results showed that the combination of functional communication training and noncontingent reinforcement was more effective at reducing stereotypy than either intervention on its own, although effects on problem behavior were unclear. These results suggest that combinations of interventions may be useful in the treatment of automatically maintained problem behavior.     

Validity of the German Test Anxiety Inventory (TAI‐G) in an Australian sample

Test anxiety (TA) is a prevalent issue among students that can result in deleterious consequences, such as underachievement. However, a contemporary measure that has been validated for use with Australian students seems to be lacking. This study, therefore, investigated the suitability of the German Test Anxiety Inventory (TAI‐G) for use with Australian university students. While the original TAI‐G contains 30 items and was designed to measure four factors (worry, emotionality, interference, and lack of confidence), differing factorial models have been supported in the literature using either the original or a shortened 17‐item version of the measure. These differing TAI‐G models were tested and compared in the current study via confirmatory factor analysis using 224 Australian university students. As expected, results supported the superior fit of the 17‐item four‐factor model. Additionally, the convergent validity of the measure was supported since measures of self‐esteem, self‐efficacy, and general anxiety were all found to correlate significantly with the TAI‐G in the hypothesised directions. Finally, the finding that all of the TAI‐G subscales had acceptably high reliabilities led to the conclusion that the 17‐item TAI‐G is a valid and reliable measure of TA in an Australian university population.     

Effects of nicotine administration via a sublingual tablet on arousal and verbal ability in non‐smokers

Tobacco smoking or nicotine administration on its own can influence cognitive task performance. This study examined the effects of acute nicotine administration on verbal task performance and a physiological index of arousal. Healthy non‐smoking participants received either a 2‐mg sublingual nicotine tablet or placebo. Participants next completed various verbal tasks while heart rate recordings were taken concurrently. Nicotine increased heart rate relative to a pre‐administration baseline period, indicating that the new method of nicotine administration increased cardiovascular arousal. Nicotine was associated with reduced accuracy in a verbal matching task and reduced accuracy and increased reaction time in an anagram task, but had no effect on performance during an analogy or verbal fluency task. The data suggest that nicotine‐naïve individuals are unlikely to gain any benefit to their verbal ability from the single acute intake of nicotine, such as that obtained from cigarette smoking or by using nicotine replacement therapy products.     

Still cautious: Personality characteristics of extremely low birth weight adults in their early 30s

Extremely low birth weight survivors (ELBW; <1000 g) display a personality style characterized by cautiousness, shyness, and risk aversion in their 20s. We examined whether non-impaired ELBW survivors were still more cautious than their normal birth weight (NBW) peers at ages 30–35 and assessed the stability of this personality characteristic across approximately a decade in the oldest known cohort of ELBW survivors. Of the 154 participants tested at ages 22–26, 111 (i.e., 72%) of them returned approximately 10 years later [i.e., 69% (49/71) ELBW and 75% (62/83) NBW], and once again they completed the Eysenck Personality Questionnaire-Revised (EPQ-R). We created the same theoretically and empirically derived composite measure of cautiousness at each visit by summing the EPQ-R psychoticism scale (reverse scored) and the EPQ-R lie scale. We found that ELBW adults reported higher cautiousness than their NBW counterparts at ages 30–35. We also found that levels of cautiousness remained stable over approximately 10 years in both groups. Our findings suggest that individuals born at ELBW were more cautious than NBW peers and that this personality characteristic remained stable into their early 30s. The present study appears to be the first empirical demonstration of personality stability among adult ELBW survivors.