Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: Therapist and patient outcomes

ObjectiveThe U.S. Department of Veterans Affairs has implemented a national dissemination and training initiative to promote the availability of Acceptance and Commitment Therapy for depression (ACT-D). This paper reports on therapist and patient outcomes associated with competency-based training in and implementation of ACT-D.MethodTherapist and patient outcomes were assessed on eleven cohorts of therapists (n = 391) and their patients (n = 745).ResultsThree-hundred thirty four therapists successfully completed all requirements of the Training Program. Ninety-six percent of therapists achieved competency by the end of training, compared to 21% at the outset of training. Mixed effects model analysis indicated therapists' overall ACT-D competency scores increased from 76 to 112 (conditional SD = 6.6), p < 0.001. Moreover, training was associated with significantly increased therapist self-efficacy and positive attitudes toward ACT-D. Therapeutic alliance increased significantly over the course of therapy. Mixed effects model analysis revealed that mean BDI-II scores decreased from 30 at baseline assessment to 19 (conditional SD = 5.6) at final assessment, t(367) = ?20.3, p < 0.001. Quality of life scores also increased.ConclusionsTraining in and implementation of ACT-D in the treatment of Veterans is associated with significant increases in therapist competency and robust improvements in patient outcomes.     

Mindfulness-Based Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder: A Case Study

With as many as 1.9 million men and women deployed as part of the wars in Iraq and Afghanistan, increased recognition is being placed on the effect of returning Veterans’ combat experiences on their adjustment and mental health, particularly those with symptoms of posttraumatic stress disorder (PTSD) and associated effects on families and relationships. Cognitive-behavioral conjoint therapy (CBCT) for PTSD is a manualized intervention with demonstrated efficacy in clinical trials with Veterans who have experienced trauma and their intimate partners. This case study involves the successful application of Mindfulness-based CBCT for PTSD to treat an operation Iraqi freedom male Veteran and his wife referred for PTSD and relationship dissatisfaction. In the current study, mindfulness interventions were integrated into the existing CBCT for PTSD protocol and treatment duration was shortened by including a weekend group retreat for couples. Baseline and post-treatment data from self- and partner-report measures demonstrates symptom reduction in posttraumatic stress symptoms as well as an increase in relationship satisfaction. The advantages of incorporating mindfulness strategies into this treatment protocol and recommendations for future work are discussed.     

Visual selective attention is equally functional for individuals with low and high working memory capacity: Evidence from accuracy and eye movements

Selective attention and working memory capacity (WMC) are related constructs, but debate about the manner in which they are related remains active. One elegant explanation of variance in WMC is that the efficiency of filtering irrelevant information is the crucial determining factor, rather than differences in capacity per se. We examined this hypothesis by relating WMC (as measured by complex span tasks) to accuracy and eye movements during visual change detection tasks with different degrees of attentional filtering and allocation requirements. Our results did not indicate strong filtering differences between high- and low-WMC groups, and where differences were observed, they were counter to those predicted by the strongest attentional filtering hypothesis. Bayes factors indicated evidence favoring positive or null relationships between WMC and correct responses to unemphasized information, as well as between WMC and the time spent looking at unemphasized information. These findings are consistent with the hypothesis that individual differences in storage capacity, not only filtering efficiency, underlie individual differences in working memory.     

Cognitive style and religiosity: The role of conflict detection

Recent research has indicated a negative relation between the propensity for analytic reasoning and religious beliefs and practices. Here, we propose conflict detection as a mechanism underlying this relation, on the basis of the hypothesis that more-analytic people are less religious, in part, because they are more sensitive to conflicts between immaterial religious beliefs and beliefs about the material world. To examine cognitive conflict sensitivity, we presented problems containing stereotypes that conflicted with base-rate probabilities in a task with no religious content. In three studies, we found evidence that religiosity is negatively related to conflict detection during reasoning. Independent measures of analytic cognitive style also positively predicted conflict detection. The present findings provide evidence for a mechanism potentially contributing to the negative association between analytic thinking and religiosity, and more generally, they illustrate the insights to be gained from integrating individual-difference factors and contextual factors to investigate analytic reasoning.     

WoMMBAT: A user interface for hierarchical Bayesian estimation of working memory capacity

The change detection paradigm has become an important tool for researchers studying working memory. Change detection is especially useful for studying visual working memory, because recall paradigms are difficult to employ in the visual modality. Pashler (Perception & Psychophysics, 44, 369–378, 1988) and Cowan (Behavioral and Brain Sciences, 24, 87–114, 2001) suggested formulas for estimating working memory capacity from change detection data. Although these formulas have become widely used, Morey (Journal of Mathematical Psychology, 55, 8–24, 2011) showed that the formulas suffer from a number of issues, including inefficient use of information, bias, volatility, uninterpretable parameter estimates, and violation of ANOVA assumptions. Morey presented a hierarchical Bayesian extension of Pashler’s and Cowan’s basic models that mitigates these issues. Here, we present WoMMBAT (Working Memory Modeling using Bayesian Analysis Techniques) software for fitting Morey’s model to data. WoMMBAT has a graphical user interface, is freely available, and is cross-platform, running on Windows, Linux, and Mac operating systems.     

Exposure to repetitive tasks induces motor changes related to skill acquisition and inflammation in rats

The authors elucidate exposure-response relationships between repetitive tasks, inflammation, and motor changes with work-related musculoskeletal disorders. Using a rat model of reaching and handle pulling, they examined effects of performing a high-repetition, low-force (HRLF); low-repetition, high-force (LRHF); or high-repetition, high-force (HRHF) task (2 hr/day, 3 days/week, 12 weeks) on reach rate and force, percentage of successful reaches, duration of participation, and grip strength. Reach rate and reach force improved with HRLF, and percentage success increased in all groups in Week 9, and in HRLF and HRHF in Week 12, indicative of skill acquisition. Duration and grip strength showed force-dependent declines with task performance. A subset of HRHF rats received ibuprofen in Weeks 5-12. Ibuprofen significantly improved reach rate, reach force, and duration in treated rats, indicative of an inflammatory influence on reach performance. Ibuprofen improved percentage of successful reaches in Week 9, although this increase was not sustained. However, declines in grip strength, a nocifensive behavior, were not prevented by ibuprofen. Examination of cervical spinal cords of untreated and ibuprofen treated HRHF rats showed increased IL-1beta, an inflammatory cytokine, in neurons. These findings suggest that only a preventive intervention could have addressed all motor declines.     

Potentiation in young infants: The origin of the prior knowledge effect?

In two experiments with 6-month-old infants, we found that prior learning of an operant task (remembered for 2 weeks) mediated new learning of a modeling event (remembered for only 1 day) and increased its recall. Infants first learned to associate lever pressing with moving a toy train housed in a large box. One or 2 weeks later, three target actions were modeled on a hand puppet while the train box (a retrieval cue) was in view. Merely retrieving the train memory strengthened it, and simultaneously pairing its retrieved memory with the modeled actions potentiated their learning and recall. When paired 1 week later, deferred imitation increased from 1 day to 4 weeks; when paired 2 weeks later, it increased from 1 day to 6 weeks. The striking parallels between potentiated learning in infants and the prior knowledge effect in adults suggests that the prior knowledge effect originates in early infancy.     

The effects of verbal operant training and response interruption and redirection on appropriate and inappropriate vocalizations

Past research has shown that response interruption and redirection (RIRD) can effectively decrease automatically reinforced motor behavior (Hagopian & Adelinis, 2001). Ahearn, Clark, MacDonald, and Chung (2007) found that a procedural adaptation of RIRD reduced vocal stereotypy and increased appropriate vocalizations for some children, although appropriate vocalizations were not targeted directly. The purpose of the current study was to examine the effects of directly targeting appropriate language (i.e., verbal operant training) on vocal stereotypy and appropriate speech in 3 children with an autism spectrum disorder. The effects of verbal operant (i.e., tact) training were evaluated in a nonconcurrent multiple baseline design across participants. In addition, RIRD was implemented with 2 of the 3 participants to further decrease levels of vocal stereotypy. Verbal operant training alone produced slightly lower levels of stereotypy and increased appropriate vocalizations for all 3 participants; however, RIRD was required to produce acceptably low levels of stereotypy for 2 of the 3 participants.     

Quality of college students' same-sex friendships as a function of personality and interpersonal competence

The aim of the current study was to investigate personality traits and interpersonal competencies as predictors of the quality of same-sex friendships in young adulthood. Undergraduate students (N = 176), who attended a mid-Atlantic U.S., medium-sized university, completed self-report surveys on their personality, interpersonal competence, and friendship quality. Sex, class status, extraversion, agreeableness, and interpersonal competencies were associated with higher friendship quality, but only the interpersonal competence of self-disclosure significantly predicted friendship quality after controlling for sex, class status, and the five personality factors.