Virtual Reality and Cognitive-Behavioral Therapy for Driving Anxiety and Aggression in Veterans: A Pilot Study

Within the U.S. military, motor vehicle accidents (MVAs) are the leading cause of preventable morbidity and mortality. Prior combat exposure and anxiety symptoms are associated with risky and aggressive driving, which is responsible for over half of MVA fatalities. Therefore, interventions are needed to reduce driving anxiety and aggression in veterans in order to mitigate the public health impact of MVAs. Virtual reality exposure therapy (VRET) offers safe, controlled exposure to distressing stimuli. The current study piloted a novel virtual reality and cognitive behavioral intervention (VRET + CBT) for veterans that integrated both anxiety and anger management components. Virtual reality driving scenarios were delivered in a driving simulator and tailored for the military population. Six previously deployed veterans completed eight intervention sessions, as well as pre/post, one month follow-up and six to nine month follow-up assessments. Repeated measures ANOVAs demonstrated significant decline and large effect sizes for PTSD symptoms, driving phobia, hyperarousal in driving situations, anxiety/anger-related thoughts and behaviors, and risky driving. Hyperarousal in driving situations declined by 69%, aggressive driving declined by 29%, and risky driving declined by 21%. Treatment gains were maintained at follow-up. Recruitment, retention, immersion, simulator sickness scores, and qualitative feedback demonstrated feasibility of the intervention. Implications for future research and adaptation are discussed.     

Keeping It Going: Evidence of Long-Term Improvements After Implementation of the 1-2-3 Magic Parenting Program

This study builds upon a pilot evaluation of the 1-2-3 Magic Program (Bailey, van der Zwan, Phelan, &; Brooks, 2012 Bailey, E. L., van der Zwan, R., Phelan, T. W., &; Brooks, A. (2012). The 1–2-3 Magic Program: Implementation outcomes of an Australian pilot evaluation with school-aged children. Child &; Family Behavior Therapy, 34(1), 53–69. doi:10.1080/07317107.2012.654455[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]), by investigating its long-term efficacy as a brief parenting intervention for families with a school-aged child. Twelve Australian families participated in a randomized controlled trial, assigned either to a wait-listed control group or to one that received immediate training. Consistent with the pilot evaluation, only families who had received training reported significant improvement in child and parenting behavior at an 8-week follow-up assessment. These improvements were maintained for 12-month posttraining, supporting the long-term efficacy of the 1-2-3 Magic Program for Australian families.     

Musical ability and non‐native speech‐sound processing are linked through sensitivity to pitch and spectral information

Is the observed link between musical ability and non‐native speech‐sound processing due to enhanced sensitivity to acoustic features underlying both musical and linguistic processing? To address this question, native English speakers (N = 118) discriminated Norwegian tonal contrasts and Norwegian vowels. Short tones differing in temporal, pitch, and spectral characteristics were used to measure sensitivity to the various acoustic features implicated in musical and speech processing. Musical ability was measured using Gordon's Advanced Measures of Musical Audiation. Results showed that sensitivity to specific acoustic features played a role in non‐native speech‐sound processing: Controlling for non‐verbal intelligence, prior foreign language‐learning experience, and sex, sensitivity to pitch and spectral information partially mediated the link between musical ability and discrimination of non‐native vowels and lexical tones. The findings suggest that while sensitivity to certain acoustic features partially mediates the relationship between musical ability and non‐native speech‐sound processing, complex tests of musical ability also tap into other shared mechanisms.     

Defining and diagnosing involuntary emotional expression disorder

Uncontrollable episodes of emotional expression occur in a variety of neurological conditions. This emotional disinhibition syndrome is characterized by episodes of crying or laughing that are unrelated to or out of proportion to the eliciting stimulus. This syndrome is common among patients with amyotrophic lateral sclerosis, multiple sclerosis, stroke, and traumatic brain injury and a variety of terms and definitions have been used to describe it. The confusing nomenclature has been a barrier to understanding, diagnosis, and treatment of this disorder. The authors propose a unifying term, involuntary emotional expression disorder (IEED), and provide diagnostic criteria for this disorder.     

Producing biased diagnoses with unambiguous stimuli: The importance of feature instantiations

In this article, the authors demonstrate a laboratory analogue of medical diagnostic biasing (V. R. LeBlanc, G. R. Norman, & L. R. Brooks, 2001) in 2 experiments and explore the basis of this effect. Before categorizing novel exemplars, participants first evaluated the likelihood that the item was a member of the category suggested on that trial: either the correct category or a plausible alternative category. This was sufficient to produce a substantial bias toward the suggested category despite the use of unambiguous stimuli, explicit rules, and unhurried conditions--each of which would be likely to limit diagnostic bias. The authors argue that the production of this effect requires distinguishing between particular feature instantiations and more abstract representations of those features as well as allowing people to adopt a particular decision strategy mediating the use of instantiated features: a feature-recognition heuristic.     

Changing food preference as a function of mood

The authors investigated the effect of mood on food selection. Participants (N = 98) indicated the likelihood of general eating and the likelihood of eating specific foods after reading and projecting themselves onto the events and emotions described in a sad and a happy vignette. Both men and women believed they were more likely to consume food following a happy versus a sad event, and men believed they were significantly more likely to eat than did women. However, the type of food men and women believed they would consume interacted with the type of event experienced. Vegetarian snack foods were more likely to be consumed following a happy versus a sad event, with men more likely to eat snack foods. Men did not significantly change in likelihood of consuming sweet foods as their mood changed. However, women believed they were more likely to consume sweet foods following a sad event. The authors discuss the results in terms of a self-medication hypothesis and the effect of carbohydrates on central serotonin and endogenous opioids. Overall, results demonstrated that mood influences belief in the likelihood of food selection.     

Frequency of stuttering during challenging and supportive virtual reality job interviews

This paper seeks to demonstrate the possibility of manipulating the frequency of stuttering using virtual reality environments (VREs). If stuttering manifests itself in VREs similarly to the way it manifests itself in real world interactions, then VREs can provide a controlled, safe, and confidential method for treatment practice and generalization. Though many researchers and clinicians recognize the need for generalization activities in the treatment of stuttering, achieving generalization in a clinical setting poses challenges to client confidentiality, safety, and the efficient use of a professionals’ time. Virtual reality (VR) technology may allow professionals the opportunity to enhance and assess treatment generalization while protecting the safety and confidentiality of their clients. In this study, we developed a VR job interview environment which allowed experimental control over communication style and gender of interviewers. In this first trial, persons who stutter (PWS) experienced both challenging and supportive VR job interview conditions. The percentage of stuttered syllables was calculated for both interviews for each participant. Self-reported ratings of communication apprehension and confidence were also obtained, and were not significantly correlated with stuttering severity. Results indicated that interviewer communication style affected the amount of stuttering produced by participants, with more stuttering observed during challenging virtual interviews. Additionally, the amount of stuttering observed during the VR job interviews was significantly, positively correlated with the amount of stuttering observed during an interview with the investigator prior to VR exposure. Participants’ subjective reports of the VR experience indicate reactions similar to those they report experiencing in the real world. Possible implications for the use of VR in the assessment and treatment of stuttering are discussed.

Educational objectives: After reading this article, the reader will be able to—(1) list some of the challenges to treatment generalization; (2) describe how virtual reality technology can assist in alleviating some of these challenges; (3) describe how the frequency of stuttering varies across two different virtual environments.     

Apparitions in the Fog Commentary on Paper by Adrienne Harris and Barbara H. Gold

Although an intersubjective analytic approach reflects postmodern concerns about the problems associated with authority and influence, it does not altogether escape them. Interpreting subjective states invokes a veiled analytic authority, and labeling them as dissociative creates a pathway for the influence of questionable assumptions about the origins of dissociation as a defense against trauma. Harris and Gold's paper can be used to illustrate these ideas.     

Addressing the Relationships Among Moral Judgment Development,Authenticity, Nonprejudice,and Volunteerism

This study addresses how moral judgment development, authenticity, and nonprejudice account for variance in scores pertaining to various motivational functions underlying volunteerism in order to clarify certain problems associated with previous research that has considered such relationships. In the study, 127 participants completed measurements that pertain to these constructs. Correlations revealed that moral judgment had a negligible relationship with both authenticity and nonprejudice, thereby affirming that the former construct is distinct from the latter two. Linear regression analyses supported that moral judgment development and nonprejudice provided the strongest contributions to the variance of the considered indices of volunteer motivation. The motivational function underlying volunteerism was also recognized as an important factor that pertains to the observed contributions of variance. Findings are discussed in concert with and compared to prior considerations of relationships between moral judgment development and considerations of the moral self. Implications where moral education is concerned are also considered.