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.     

Task and distribution sampling affect auditory category learning

There is substantial evidence that two distinct learning systems are engaged in category learning. One is principally engaged when learning requires selective attention to a single dimension (rule-based), and the other is drawn online by categories requiring integration across two or more dimensions (information-integration). This distinction has largely been drawn from studies of visual categories learned via overt category decisions and explicit feedback. Recent research has extended this model to auditory categories, the nature of which introduces new questions for research. With the present experiment, we addressed the influences of incidental versus overt training and category distribution sampling on learning information-integration and rule-based auditory categories. The results demonstrate that the training task influences category learning, with overt feedback generally outperforming incidental feedback. Additionally, distribution sampling (probabilistic or deterministic) and category type (information-integration or rule-based) both affect how well participants are able to learn. Specifically, rule-based categories are learned equivalently, regardless of distribution sampling, whereas information-integration categories are learned better with deterministic than with probabilistic sampling. The interactions of distribution sampling, category type, and kind of feedback impacted category-learning performance, but these interactions have not yet been integrated into existing category-learning models. These results suggest new dimensions for understanding category learning, inspired by the real-world properties of auditory categories.     

Understanding the Association Between Spirituality,Religiosity, and Feelings of Happiness and Sadness Among HIV-Positive Indian Adults: Examining Stress-Related Growth as a Mediator

This study examined the role of stress-related growth as a mediator of the associations between spirituality, religiosity, and feelings of happiness and sadness in a sample of 178 HIV-positive Indian adults. Results indicated that spirituality, but not religiosity, was associated with feelings of happiness and sadness. Subsequent mediation analyses indicated that stress-related growth fully mediated the relationships involving spirituality and feelings of happiness and sadness. Overall, our findings point to the importance of facilitating greater spiritual development among HIV-positive Indians, as well as promoting strategies that help them develop and apply stress-related growth coping methods in their lives.     

Leaving to Love: Filipina Caregivers and The Queer Kinship of Transnational Childcare

This article considers the affective and psychosocial dimensions of transnational childcare. It offers a transdisciplinary engagement with the subjectivity of Filipina caregivers, suggesting that the ways in which their love and care are split across borders and nations “queers” conceptions of family, childhood, and maternal obligation. Specifically, queer theories of kinship and diaspora are employed to offer an affective reading of Canada’s Caregiver Program. D. W. Winnicott’s theory of the “good enough” mother is also engaged in an effort to complicate narratives of maternal obligation, neglect, and love.     

Bidirectional Associations between Peer Victimization and Functions of Aggression in Middle Childhood: Further Evaluation across Informants and Academic Years

The current 3-wave study examined bidirectional associations between peer victimization and functions of aggression across informants over a 1-year period in middle childhood, with attention to potential gender differences. Participants included 198 children (51% girls) in the third and fourth grades and their homeroom teachers. Peer victimization was assessed using both child- and teacher-reports, and teachers provided ratings of reactive and proactive aggression. Cross-classified multilevel cross-lagged models indicated that child-reports, but not teacher-reports, of peer victimization predicted higher levels of reactive aggression within and across academic years. Further, reactive aggression predicted subsequent increases in child- and teacher-reports of peer victimization across each wave of data. Several gender differences, particularly in the crossed paths between proactive aggression and peer victimization, also emerged. Whereas peer victimization was found to partially account for the stability of reactive aggression over time, reactive aggression did not account for the stability of peer victimization. Taken together with previous research, the current findings suggest that child-reports of peer victimization may help identify youth who are risk for exhibiting increased reactive aggression over time. Further, they highlight the need to target reactively aggressive behavior for the prevention of peer victimization in middle childhood.     

The context-specific proportion congruent Stroop effect: Location as a contextual cue

The Stroop effect has been shown to depend on the relative proportion of congruent and incongruent trials. This effect is commonly attributed to experiment-wide word-reading strategies that change as a function of proportion congruent. Recently, Jacoby, Lindsay, and Hessels (2003) reported an itemspecific proportion congruent effect that cannot be due to these strategies and instead may reflect rapid, stimulus driven control over word-reading processes. However, an item-specific proportion congruent effect may also reflect learned associations between color word identities and responses. In two experiments, we demonstrate a context-specific proportion congruent effect that cannot be explained by such word—response associations. Our results suggest that processes other than learning of word—response associations can produce contextual control over Stroop interference.     

The concept of risk and responsible conduct of research

Assessment of risk is one of the key issues in the field of responsible conduct of research which covers discourses of research ethics and research integrity. The principle of minimizing risks and balancing of risks and benefits is one of the main requirements of research ethics. In addition, the content of informed consent that is another fundamental principle of research ethics derives from the assessment of risks and benefits related to a particular research project. Risk assessment also plays a crucial role in methodological design of the research project. This is an important point where research ethics and research integrity discourses overlap. Firstly, because the choice of a control group (e.g., placebo control) is a key ethical issue related to the protection of the research subjects' interests. Secondly, because the quality of the research data, that is one of the key elements of research integrity, is closely connected to the choice of research methodology as well. The problem of biased interpretation or manipulation of risk related features of biomedical research should also be taken into account. Despite the importance of the concept of risk to the field of biomedical research, its relevance has not yet attracted a sufficient attention in the responsible conduct of research debate.     

The protection of patients’ rights in clinical trials

The Helsinki Declaration is a very important document regarding the protection of patients’ rights in clinical trials and one of the fundamental sources of operational principles for every ethics committee. Although they have been updated, the international guidelines for ethics committees continually fail to address certain issues pertaining to the protection of patients’ rights in clinical trials. These issues include, most significantly, the method of electing ethics committees (a free, secret ballot should be preferred to direct appointment), the avoidance of conflict of interest during the election of ethics committee members, and the necessary insurance coverage for the participants of clinical trials. Polish law should, on the other hand, be developed in such way as to not limit the effectiveness of ethics committees in protecting patients’ rights in clinical trials. The ideal solution would be to draft a uniform law concerning not only clinical trials, but all medical experiments. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005. The author is Chairman, Bioethics Committee of the Warsaw Regional Chamber of Physicians and Dentists.     

The mentor and the trainee in academic clinical medicine

Medicine is a scientific discipline, but it is sometimes difficult to separate what is scientific and what is a clinical, practical activity. Man is the object, but he is always the subject of medical research and therefore these two elements become closely bound together by a thread of moral interdependencies. Every mentor of a young academic and all institutions dealing with the teaching of and research into medicine must understand multidimensional, multifaceted, and multilevel aspects of their activity and give them due regard in the educational process. The educational mission of an academic institution and of the teacher working there may be summed up in one phrase: Teach thinking! At the same time, the task of a school and the individual mentor is to teach the student to distinguish personal freedom from a lack of the feeling of responsibility. The medieval principle “Universitas magistrorum et scholarium”, and thus the corporation, the community of teachers and students, has not lost any of its relevance and value today. The situation is, in its far-reaching consequences, tragic in which the “insufficiently tutored teach”. Both physician and teacher, and especially physician-teacher, are not only professions, but also callings. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005.