Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl

The alpha-2 adrenergic receptor antagonist, yohimbine, can facilitate fear extinction in animals and humans. One potential mechanism is increased noradrenergic activity and associated arousal in the presence of conditioned stimuli. Accordingly, yohimbine might augment prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD), where heightened exposure-oriented arousal is a theorized driver and empirical predictor of treatment success. A double-blind placebo-controlled randomized trial (NCT 01031979) piloted yohimbine augmentation in 26 males with combat-related PTSD. Participants were given one-time dose of yohimbine or placebo prior to the first imaginal exposure. Subsequently, both arms completed standard PE. The primary outcome was trauma-cued heart-rate reactivity a week after the drug/exposure visit, a highly specified, objective measure sensitive to incremental change. Secondary outcomes included arousal during the drug/exposure visit and slope of distress, PTSD, and depression over the course of PE. Consistent with hypothesis, yohimbine led to higher objective and subjective arousal during the drug/exposure visit and to lower trauma-cued heart-rate reactivity one-week later. One dose of yohimbine also led to greater between-session habituation and more rapid improvement on depression, but not PTSD, over the course of care. Results of this controlled pilot indicate support for continued investigation of yohimbine-augmented exposure therapy for PTSD.     

Validity of Adolescent and Parent Reports on the Six-Item ADHD Self-Report Scale (ASRS-6) in Clinical Assessments of Adolescent Social Anxiety

Adolescents experiencing social anxiety often experience co-occurring attention-deficit/hyperactivity disorder (ADHD) symptoms. Yet, assessing for social anxiety poses challenges given the already time-consuming task of distinguishing social anxiety from other commonly co-occurring internalizing conditions (e.g., generalized anxiety, major depression). Assessors need short screening devices to identify socially anxious adolescents in need of intensive ADHD assessments. A six-item version of the ADHD Self-Report Scale (ASRS-6) was originally developed to identify adults who likely meet diagnostic criteria for ADHD, but its psychometric properties have yet to be examined among adolescents. We tested the psychometric properties of the ASRS-6 when administered in clinical assessments for adolescent social anxiety. Eighty-nine 14–15 year old adolescents and their parents (67.4% female; 62.1% African American; 30 Clinic-Referred; 59 Community Control) completed the ASRS-6, measures of adolescent social anxiety and depressive symptoms, and parent-adolescent conflict. Adolescent self-reported and parent-reported ASRS-6 positively related with scores from established measures of social anxiety, depressive symptoms, and parent-adolescent conflict. Further, adolescent self-reported (but not parent-reported) ASRS-6 scores significantly discriminated adolescents on referral status. Adolescent self-reported (but not parent-reported) ASRS-6 scores incrementally predicted social anxiety over-and-above depressive symptoms, which commonly co-occur with social anxiety. Conversely, parent-reported (but not adolescent self-reported) ASRS-6 scores incrementally predicted parent-adolescent conflict over-and-above depressive symptoms, which commonly co-occur with conflict. When assessing adolescent ADHD symptoms, adolescents’ and parents’ reports meaningfully vary in their links to validity indicators. As such, among adolescents assessed for social anxiety, clinical assessments of adolescent ADHD symptoms should include both parent reports and adolescent self-reports.     

Introduction: education and migration

ABSTRACT

This introduction expounds educational problems that arise from transnational migration. It argues that it is high time to critically analyze normative issues of and in education under conditions of globalization because dominant approaches in normative philosophy of education tend to suffer from both a nationalist bias and a sedentary bias. The contributions to this special issue address normative problems pertaining to migration-related education from a variety of ethical and philosophical perspectives, including analytic applied ethics, continental philosophy, care ethics, Hegelian philosophy, the capability approach and theories of distributive justice. They discuss the education of both citizens and migrants in the receiving society as well as in the country of origin, focusing on ethical issues pertaining to access to education as well as to the content of educational programs.     

Acceptability,Feasibility, and Effectiveness of Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in New York

Cognitive-behavioral therapy (CBT), consisting of exposure and response prevention (EX/RP), is both efficacious and preferred by patients with obsessive–compulsive disorder (OCD), yet few receive this treatment in practice. This study describes the implementation of an Internet-based CBT program (ICBT) developed in Sweden in individuals seeking OCD treatment in New York. After translating and adapting the Swedish ICBT for OCD, we conducted an open trial with 40 adults with OCD. Using the RE-AIM implementation science framework, we assessed the acceptability, feasibility, and effectiveness of ICBT. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Of 40 enrolled, 28 participants completed the 10-week ICBT. In the intent-to-treat sample (N = 40), Y-BOCS scores decreased significantly over time (F = 28.12, df = 2, 49, p < . 001). Depressive severity (F = 5.87, df = 2, 48, p < . 001), and quality of life (F = 12.34, df = 2, 48, p < . 001) also improved. Sensitivity analyses among treatment completers (N = 28) confirmed the intent-to-treat results, with a large effect size for Y-BOCS change (Cohen’s d = 1.38). ICBT took less time to implement than face-to face EX/RP and participants were very to mostly satisfied with ICBT. On a par with results in Sweden, the adapted ICBT program reduced OCD and depressive symptoms and improved quality of life among individuals with moderate to severe OCD. Given its acceptability and feasibility, ICBT deserves further study as a way to increase access to CBT for OCD in the United States.     

An evaluation of a visual–visual successive matching‐to‐sample procedure to establish equivalence classes in adults

Traditionally, behavior analysts have studied stimulus equivalence using a matching‐to‐sample (MTS) preparation. Although researchers have shown the utility of MTS to yield equivalence classes, the procedure requires several prerequisite skills for a learner to accurately respond. Previous research with humans and nonhumans has shown that relational responding can be produced via compound stimulus discrimination and successive matching‐to‐sample (S‐MTS). We conducted four experiments with college students to further evaluate the effectiveness of S‐MTS in the establishment of stimulus relations. S‐MTS trials consisted of the presentation of a single sample stimulus followed by one comparison in a fixed location on a computer screen. Depending upon the sample–comparison relation, participants touched (i.e., go) or did not touch (i.e., no‐go) the comparison stimulus. Following training of the baseline relations (AB/BC), we assessed the emergence of symmetry, transitivity, and equivalence performances (i.e., BA/CB and AC/CA). Results support the utility of the S‐MTS procedure as a possible alternative to traditional MTS. This study has direct implications for participants for whom traditional three‐array MTS procedures may be challenging.     

Interpersonal effects of strategic and spontaneous guilt communication in trust games

A social partner’s emotions communicate important information about their motives and intentions. However, people may discount emotional information that they believe their partner has regulated with the strategic intention of exerting social influence. Across two studies, we investigated interpersonal effects of communicated guilt and perceived strategic regulation in trust games. Results showed that communicated guilt (but not interest) mitigated negative effects of trust violations on interpersonal judgements and behaviour. Further, perceived strategic regulation reduced guilt’s positive effects. These findings suggest that people take emotion-regulation motives into account when responding to emotion communication.     

Shifts of spatial attention cued by irrelevant numbers: Electrophysiological evidence from a target discrimination task

Fischer et al. demonstrated that a centrally presented number can shift attention to the left/right when its magnitude is small/large. Two electrophysiological studies described these attentional effects as event-related potentials (ERPs) at centro-parietal sites. Since both studies used target detection tasks, it remains currently unknown whether similar results would be obtained with a discrimination task. We used ERPs to test whether digit cues also induce attention shifts when participants perform a feature-discrimination task on targets. ERPs were recorded whereas subjects discriminated the colour of lateral targets that were preceded by a central non-predictive digit. Analysis of cue-locked controlateral vs. ipsilateral ERP activity showed the emergence of early preparatory attention-directing components in parietal and frontal regions. Moreover, target-locked P1 components at occipito-parietal sites were significantly modulated by digit magnitude-target side congruency. These results demonstrate that irrelevant digit cues also bias sensory processing when embedded in a feature-discrimination task.