Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

The impacts of ignoring individual mobility across clusters in estimating a piecewise growth model

A three-level piecewise growth model (3L-PGM) can be used to break up nonlinear growth into multiple components, providing the opportunity to examine potential sources of variation in individual and contextual growth within different segments of the model. The conventional 3L-PGM assumes that the data are strictly hierarchical in nature, where measurement occasions (level 1) are nested within individuals (level 2) who are members of a single cluster (level 3). However, in longitudinal research, it is sometimes difficult for data structures to remain purely clustered during a study, such as when some students change classrooms or schools over time. One resulting data structure in this situation is known as a multiple membership structure, where some lower-level units are members of more than one higher-level unit. The new multiple membership PGM (MM-PGM) extends the 3L-PGM to handle multiple membership data structures frequently found in the social sciences. This study sought to examine the consequences of ignoring individual mobility across clusters when estimating a 3L-PGM in comparison to estimating a MM-PGM. MM-PGM estimates were less biased (especially in the cluster-level coefficient estimates), although we found substantial bias in cluster-level variance components across some conditions for both models.     

More Aboutness in Imagination

Journal of Philosophical Logic - In Berto’s logic for aboutness in imagination, the output content of an imaginative episode must be part of the initial content of the episode (Berto, Philos...     

Human social defeat and approach–avoidance: Escalating social-evaluative threat and threat of aggression increases social avoidance

Basic research on avoidance by Murray Sidman laid the foundation for advances in the classification, conceptualization and treatment of avoidance in psychological disorders. Contemporary avoidance research is explicitly translational and increasingly focused on how competing appetitive and aversive contingencies influence avoidance. In this laboratory investigation, we examined the effects of escalating social-evaluative threat and threat of social aggression on avoidance of social interactions. During social-defeat learning, 38 adults learned to associate 9 virtual peers with an increasing probability of receiving negative evaluations. Additionally, 1 virtual peer was associated with positive evaluations. Next, in an approach–avoidance task with social-evaluative threat, 1 peer associated with negative evaluations was presented alongside the peer associated with positive evaluations. Approaching peers produced a positive or a probabilistic negative evaluation, while avoiding peers prevented a negative evaluation (and forfeited a positive evaluation). In an approach–avoidance task with social aggression, virtual peers gave and took money away from participants. Escalating social-evaluative threat and aggression increased avoidance, ratings of feeling threatened and threat expectancy and decreased ratings of peer favorableness. These findings underscore the potential of coupling social defeat and approach–avoidance paradigms for translational research on the neurobehavioral mechanisms of social approach–avoidance decision-making and anxiety.     

Jail‐based competency treatment comes of age: Multi‐site outcomes and challenges to the implementation of an evidence‐based forensic continuum

The jail‐based competency treatment (JBCT) model has become an established forensic practice across the country. From the perspective of implementation science and the three core elements of the Promoting Action on Research Implementation in Health Service (PARiHS) framework, the JBCT model is a remarkable example of how context (an unrelenting and overwhelmingly strong demand for forensic beds) has driven multiple state governments to facilitate implementation of a methodology in the absence of empirical evidence supporting its efficacy. This 7‐year study of outcomes from four JBCT program sites provides this much‐needed evidence by showing that JBCT restored 56% of 1553 male and 336 female patients over an average of 48.7 days. At the same time, the study highlights how variations in JBCT models, methods, and preadmission stabilization time present challenges to planned and effective implementation of evidence‐based practice at the statewide system level. By identifying differential responsiveness to JBCT treatment by diagnosis and other factors, the study suggests preliminary implementation ideas for what types of patients are well served by the JBCT model as part of a continuum of restoration options that includes inpatient, outpatient and diversion. Significant findings showed that JBCT patients were restored at a higher rate and in a shorter time if they were female, < 20 years old (highest restoration rate; those < 60 years old also significantly better rates), free of co‐occurring intellectual and cognitive deficits, and malingering. Of the major diagnoses, schizoaffective disorder required a significantly longer length of JBCT treatment for restoration, and lower restoration rates than schizophrenia and bipolar disorder, although this was moderated by a significant interaction with abuse of amphetamines.     

A Prospective Study of Maternal Exposure to Smoking during Pregnancy and Behavioral Development in the Child

Prenatal smoke exposure (PSE) is a risk factor for adverse outcomes in the offspring, including those affecting psychological development. However, it is uncertain whether these associations are the direct result of PSE or other confounding factors. The aim of this study was to examine the possible relationship between PSE and behavioral development in children at 7.5 years of age, considering several prenatal, neonatal and postnatal covariates. A cohort of 266 mother-child pairs was followed from the first trimester of pregnancy until the children reached 7.5 years of age. PSE was assessed using a questionnaire from prenatal clinical records and corroborated by plasma cotinine determinations in the first and second trimesters and in the cord. Mother-child pairs were classified into one of four groups: unexposed, exposed to passive smoking, first trimester active smoking only and active smoking throughout pregnancy. Child behavior was assessed using the Child Behavior Checklist for ages 6–18 and the Childhood Autism Spectrum Test. In multiple linear regression models, smoking during pregnancy was associated with higher scores in affective problems (β?=?0.298; p?=?0.004). No significant associations were found between smoking during pregnancy and externalizing problems. Findings indicate that PSE is negatively associated with behavioral development in childhood.

     

Death Attitudes,Palliative Care Self-efficacy,and Attitudes Toward Care of the Dying Among Hospice Nurses

Journal of Clinical Psychology in Medical Settings - Previous research has linked death attitudes, palliative care self-efficacy, and attitudes toward care of the dying among nursing students and...     

A Systematic Review of Self-Report Measures of Negative Self-Referential Emotions Developed for Non-Clinical Child and Adolescent Samples

Clinical Child and Family Psychology Review - The crisis in child and adolescent mental health and wellbeing has prompted the development of school and community-based interventions to tackle...     

Validity of the multiple-stimulus without replacement preference assessment for edible items

Studies have shown that the multiple-stimulus without replacement (MSWO) preference assessment is an effective assessment format for identifying preferred items. However, it is possible that factors other than reinforcer quality might influence selections by some individuals when the MSWO array consists of edible items. The validity of the MSWO results was evaluated by comparing items identified as most and least preferred by the MSWO assessment in a concurrent-schedule (CS) format. Varying edible items were used in each study. The MSWO format accurately identified the higher quality edible item for most participants across studies (76%); however, the MSWO format did not predict the highest quality edible item in the CS assessment for 20% to 30% of participants in each study.