Responses to symptom induction exercises in panic disorder

Exposure to panic symptoms (interoceptive exposure) is often included as part of treatment for panic disorder (PD), although little is known about the relative effects of particular symptom induction exercises. This study describes responses of individuals with PD and nonclinical controls to 13 standard symptom induction exercises and 3 control exercises. Generally, individuals with PD responded more strongly to symptom induction exercises than did controls. The exercises producing the most fear included spinning, hyperventilation, breathing through a straw, and using a tongue depressor. This study also reports findings regarding specific symptoms triggered by each exercise, the percentage of participants reporting fear during each exercise, and predictors of fear.     

The aim of the training analysis

Although the training analysis is considered by many to be the most important element of a candidate's analytic training, its aim remains unclear. Some think of the training analysis as being a strictly therapeutic tool, while others assign it a more frankly educational role. This paper reviews the literature on this topic from Freud to the present, discusses the problems that lack of clarity about the aim of the training analysis generates for psychoanalytic education, and proposes future research in this area.     

Social learning in pig-tailed macaques (Macaca nemestrina) and adult humans (Homo sapiens) on a two-action artificial fruit

An artificial fruit (AF) was used to test for social learning in pig-tailed macaques (Macaca nemestrina) and adult humans (Homo sapiens). A monkey demonstrator opened the AF, showing alternative methods to 2 groups of cage mates. Video films of the monkey demonstrations were presented to adult humans. Compared with chimpanzees and children, the macaques watched the demonstrations significantly less and in a much more sporadic manner. They also produced only very weak and transitory evidence of social learning. In contrast, the adult humans performed as one might expect of optimum imitators, even producing evidence of components of a "ratchet effect."     

Loss aversion is an affective forecasting error

Loss aversion occurs because people expect losses to have greater hedonic impact than gains of equal magnitude. In two studies, people predicted that losses in a gambling task would have greater hedonic impact than would gains of equal magnitude, but when people actually gambled, losses did not have as much of an emotional impact as they predicted. People overestimated the hedonic impact of losses because they underestimated their tendency to rationalize losses and overestimated their tendency to dwell on losses. The asymmetrical impact of losses and gains was thus more a property of affective forecasts than a property of affective experience.     

The relationship between pre-treatment clinical profile and treatment outcome in an integrated stuttering program

A procedure for subtyping individuals who stutter and its relationship to treatment outcome is explored. Twenty-five adult participants of the Comprehensive Stuttering Program (CSP) were classified according to: (1) stuttering severity and (2) severity of negative emotions and cognitions associated with their speech problem. Speech characteristics (percentage of stuttered syllables, distorted speech score, and the number of correctly produced syllables on a diadochokinesis task) and emotional/cognitive states (emotional reaction, speech satisfaction, and attitudes toward speaking) were assessed before and after treatment, and at a 1- and 2-year follow-up. The results showed that: (a) there was no relationship between stuttering severity and the severity of negative emotions and cognitions, (b) the severe stuttering group had the largest treatment gains but also the highest level of regression, and (c) at post-treatment and both follow-up assessments the differences on measures of emotions between the mild and severe emotional group had disappeared, chiefly due to a large decrease in the latter group's negative emotions and cognitions. Our findings show that, based on treatment gains, specific subgroups can be identified, each requiring different treatment approaches. This underlines the necessity of developing a better understanding of how various dimensions of stuttering relate to treatment outcome. Educational objectives: The reader will be able to: (1) describe why stuttering severity and negative emotions and cognitions that are related to stuttering should be investigated separately and (2) describe how treatment outcome relates to subtypes of persons who stutter.     

Therapeutic Assessment With Children: Intervening With Parents “Behind the Mirror”

All the steps in the model of therapeutic assessment used with children (TA–C) are designed to involve and impact the child's parents. However, a distinctive process that parallels and accompanies the testing sessions with the child might be the most significant in helping parents shift their story of their child and family. In this process, parents are invited to observe their child's testing sessions (in an adjacent room through a live video feed, through a 1-way mirror, or in the corner of the testing room) and process the experience with the assessor (either simultaneously in the case of the 2-assessor model or after the fact in the 1-assessor model). We discuss the development and evolution of what we have come to call the “behind the mirror” method. We describe the therapeutic intent of the method and delineate 13 techniques utilized to enlist parents as active collaborators. We illustrate each technique using the case study of a 10-year-old boy where the 2-assessor model and live video feed method were used. We also provide research findings from the case study that address the parents’ experience of the assessment and their changed view of their child.     

Interview anxiety across the sexes: Support for the sex-linked anxiety coping theory

The sex-linked anxiety coping theory states that females’ anxiety levels may be less detrimental to their selection test performance because they have more available coping resources and engage in more constructive coping strategies prior to and during selection tests. This research project sought to investigate whether gender moderates the link between interview anxiety and interview performance. Co-op students (N = 125) participated in a mock interview as part of a course requirement. The results indicated that gender moderated the relation between self-rated interview anxiety and interview performance. Males were no more anxious than were females, but experienced significantly greater impairments to performance in the job interview as a result of interview anxiety. Of interest, interviewer-rated interview anxiety did not interact with gender to predict interview performance, which supports preliminary research evidence that perceptions and the experience of interview anxiety are not necessarily congruent.     

Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

A Randomized Trial of Attention Training for Generalized Social Phobia: Does Attention Training Change Social Behavior?

The use of attention training protocols for the treatment of generalized social anxiety disorder (SAD) is undergoing increased examination. Initial investigations were positive but more recent investigations have been less supportive of the treatment paradigm. One significant limitation of current investigations is overreliance on self-report. In this investigation, we expanded on initial investigations by using a multimodal assessment of patient functioning (i.e., including behavioral assessment). Patients with a primary diagnosis of SAD (n = 31) were randomly assigned to eight sessions of attention training (n = 15) or placebo/control (n = 16). Participants were assessed at pre- and posttreatment via self- and clinician-report of social anxiety as well as anxious and behavioral response to two in vivo social interactions. Results revealed no differences between groups at posttreatment for all study outcome variables, suggesting a lack of effect for the attention training condition. The results are concordant with recent investigations finding a lack of support for the use of attention training as an efficacious treatment for patients with SAD.     

Artifacts as Conventional Objects

What underlies children's understanding of artifacts? Studies suggest that beginning around age 7, people reason about artifacts in terms of the inventor's purpose—termed the design stance. Our two studies emphasize another component of artifact understanding—the cultural nature of artifacts—by demonstrating people's sensitivity to an artifact's conventional use. In past studies participants were shown a novel artifact and told that someone invented it for a certain purpose and that later another person used it for a different purpose. Here we demonstrate that if participants are told that many people, as opposed to just one person, use an artifact differently, 5-year-olds, 7-year-olds, and adults do not strictly judge the artifact in terms of its invented purpose. We conclude that people's conceptions of artifacts are more complex and dynamic than has been suggested.