The effects of marital adjustment and spouse involvement on the behavioral treatment of agoraphobia: A meta-analytic review

Abstract

In a meta-analysis of 12 recently published therapy outcome studies, the effects of marital distress and spouse-involved therapy on the outcome of exposure-based treatments for agoraphobiawere evaluated. Analyses indicated that the better the pre-treatment marital functioning of the patient, the greater the reduction in agoraphobic symptomatology up to one year following treatment. The effectiveness of spouse-involved exposure treatment, at least as currently practiced, was not found to be significantly different from the effectiveness of the more commonly used spouse-noninvolved exposure treatments. Specific research suggestions which may assist in providing a better understanding of the relations among agoraphobia, marital functioning, treatment modality, and treatment outcome are offered. In addition, we present guidelines for the conduct and reporting of future agoraphobia treatment research.     

Delay and déjà vu: Timing and repetition increase the power of false evidence

False images and videos can induce people to believe in and remember events that never happened. Using a novel method, we examined whether the timing of false evidence would influence its effect (Experiment 1) and determined the relationship between timing and repetition (Experiment 2). Subjects completed a hazard perception driving test and were falsely accused of cheating. Some subjects were shown a fake video or photograph of the cheating either after a 9-min delay (Experiment 1) or more than once with or without a delay (Experiment 2). Subjects were more likely to falsely believe that they had cheated and to provide details about how the cheating happened when the false evidence was delayed or repeated—especially when repeated over time—relative to controls. The results show that even a strikingly short delay between an event and when false evidence is disclosed can distort people’s beliefs and that repeating false evidence over a brief delay fosters false beliefs more so than without a delay. These findings have theoretical implications for metacognitive models of autobiographical memory and practical implications for police interrogations.     

Maternal Empathy and Changes in Mothers’ Permissiveness as Predictors of Toddlers’ Early Social Competence with Peers: A Parenting Intervention Study

The goal of the current study was to examine how changes in parenting due to a parenting intervention designed to decrease permissive parenting affected the quality of children’s peer interactions. Forty-nine mothers of toddlers aged 2–3 years participated in a 12-week intervention in which half got hands-on training and practice using positive guidance in a toddler classroom setting, while the other half learned positive guidance solely via a seminar format. To observe children’s peer interactions, toddlers were divided into 8 groups of 5–7 children mixed across condition. Observers coded mothers’ empathy, permissiveness, and positive guidance parenting strategies. Children’s peer interactions were coded for antisocial behaviors, verbal aggression, physical aggression, prosocial behaviors, positive social bids, and empathy. Prior analysis of this intervention indicated that mothers in both conditions showed reductions in permissiveness over the course of the intervention. Results from the present study indicated that reductions in permissiveness predicted decreases in toddlers’ verbal aggression. Maternal empathy was a moderator such that mothers low in empathy who got hands-on training in positive guidance had children who demonstrated the greatest reductions in antisocial behaviors.     

Early Negative Affect Predicts Anxiety, not Autism, in Preschool Boys with Fragile X Syndrome

Children with fragile X syndrome (FXS) face high risk for anxiety disorders, yet no studies have explored FXS as a high-risk sample for investigating early manifestations of anxiety outcomes. Negative affect is one of the most salient predictors of problem behaviors and has been associated with both anxiety and autistic outcomes in clinical and non-clinical pediatric samples. In light of the high comorbidity between autism and anxiety within FXS, the present study investigates the relationship between longitudinal trajectories of negative affect (between 8 and 71 months) and severity of anxiety and autistic outcomes in young males with FXS (n?=?25). Multilevel models indicated associations between elevated anxiety and higher fear and sadness, lower soothability, and steeper longitudinal increases in approach. Autistic outcomes were unrelated to negative affect. These findings suggest early negative affect differentially predicts anxiety, not autistic symptoms, within FXS. Future research is warranted to determine the specificity of the relationship between negative affect and anxiety, as well as to explore potential moderators. Characterizing the relationship between early negative affect and anxiety within FXS may inform etiology and treatment considerations specific to children with FXS, as well as lend insight into precursors of anxiety disorders in other clinical groups and community samples.     

False recognition of objects in visual scenes: Findings from a combined direct and indirect memory test

We report an extension of the procedure devised by Weinstein and Shanks (Memory & Cognition 36:1415–1428, 2008) to study false recognition and priming of pictures. Participants viewed scenes with multiple embedded objects (seen items), then studied the names of these objects and the names of other objects (read items). Finally, participants completed a combined direct (recognition) and indirect (identification) memory test that included seen items, read items, and new items. In the direct test, participants recognized pictures of seen and read items more often than new pictures. In the indirect test, participants’ speed at identifying those same pictures was improved for pictures that they had actually studied, and also for falsely recognized pictures whose names they had read. These data provide new evidence that a false-memory induction procedure can elicit memory-like representations that are difficult to distinguish from “true” memories of studied pictures.     

Free viewing perceptual asymmetries for judgment of brightness and quantity: dependence on stimulus orientation

Previous research has indicated that normals exhibit strong leftward biases during free-viewing perceptual judgments of brightness and quantity. When participants view two symmetrical objects and they are forced to choose which object appears darker or more numerous, participants usually select the stimulus with the relevant feature on the left side. The present study investigated the possibility that these perceptual asymmetries are dependent on scanning a stimulus horizontally across the midline by administering a task with two rectangular reversed stimuli presented either horizontally or vertically. When the stimuli were presented horizontally (crossing the midline), participants exhibited leftward biases, but these biases disappeared when the stimuli were presented vertically. This result supports the position that free-viewing perceptual asymmetries are dependent on scanning the stimuli across the midline.     

Changes in health status after one year for persons at-risk for and with HIV infection

Abstract

Health status is an important component of the evaluation of patient outcome in HIV infection where disease is chronic, progressive, and debilitating. This paper compares patient self-report for 9 dimensions of health status for patients followed in ATHOS (AIDS Time-Oriented Health Outcome Study). We compared changes in functioning after 12 months for 1, 524 patients with varying HIV disease severity: 238 asymptomatic, 447 symptomatic, 441 AIDS, and 398 HIV-negative individuals who are at-risk for infection.

Declines in health status were observed for all HIV-infected persons, including also asymptomatic patients. Individuals with symptomatic disease or AIDS had significant declines (p < 0.001) in physical functioning, energy, global health, pain, and increased disease symptoms, but no significant declines in health distress, cognition, or mental health. Persons with AIDS had greater declines than those with symptomatic disease. All HIV-infected individuals reported significantly fewer hours at work and more disability days than HIV-negative patients from similar risk pools. The adverse impact that HIV infection has on the health status of HIV-positive asymptomatic individuals is striking; HIV-negative individuals are more similar to HIV-positive individuals than to the general population.     

Use of correlational data to examine the effects of risk perceptions on precautionary behavior

Abstract

The idea that perceptions of high personal risk lead people to adopt precautionary behavior (the “motivational hypothesis”) is mainly tested with correlational data. A review of studies from selective journals reveals a high proportion with methodological and conceptual problems that make them invalid as tests of this hypthesis. Three problems arc emphasized: (1) the misinterpretation of correlations from cross-sectional studies as testing the motivational hypothesis when they actually indicate the accuracy of risk perceptions; (2) the failure to control for prior behavior in prospective studies; and (3) the we of prospective studies in situations of little behavior change. Path models are used to help explain these problems. Recommendations for selecting research designs and for calculating the least problematic correlations are given, along with warnings about the many assumptions needed to interpret even these correlations.

Summary

Overall, 27 of the 61 cross-sectional analyses listed in Tables 2 and 3 were conducted using clearly inappropriate variables. The appropriateness of the remaining correlations rest on one or two rather questionable assumptions: (1) that people do not distort their risk perceptions to justify their behavior or intentions and (2) that negative screening results a problem like breast cancer do not affect perceptions of future risk. The correlations preferred for testing the motivational hypothesis are listed in Table 4.

Summary

When the amount of precautionary behavior in a population has become relatively stable and behavior at time t+1 is well-predicted from behavior at time t, no independent variable other than B_t will have much predictive value in a prospective design. To avoid this problem, research should be conducted at a time when a substantial change in behavior is occurring, such as soon after the risk is recognized. If this is not possible, interventions that lead people to change their behavior (e.g., by raising risk perceptions or by lowering barriers to action) are required. In effect, they remove the system from equilibrium and allow one to watch what happens as people seek a new equilibrium. The least satisfactory choice is to use a cross-sectional correlation, such as R _H?B, that represents a summation over previous changes in behavior. The assumptions required to interpret such a correlation have been discussed earlier.     

The use of diabetes-specific perceived control and health belief measures to predict treatment choice and efficacy in a feasibility study of continuous subcutaneous insulin infusion pumps

Abstract

In the course of a feasibility study of continuous subcutaneous insulin infusion pumps, 382 insulin-requiring diabetic patients were offered a choice of CSII, intensified conventional treatment or conventional treatment. Two hundred and eighty-six (75%) patients completed newly developed diabetes-specific measures of health beliefs and attributions before any change of treatment regimen. The scales were useful predictors of patients' choice of treatment. Furthermore, they were useful in predicting efficacy of treatment in terms of glycosylated haemoglobin measures of diabetes control after one year of treatment in the study. The implications of the findings for introducing patients to new forms of treatment are discussed.     

Sleep Disturbances Among Combat Military Veterans: A Comparative Study Using Subjective and Objective Sleep Assessments

The sleep characteristics of 37 military veterans and active-duty service members (17 with PTSD and 20 without PTSD) of recent wars were analyzed to determine if combat deployment, with its associated sleep restriction, may be an alternative explanation for the sleep complaints found among combat veterans with PTSD (as determined by PTSD Checklist Military Version scores). Over a 1-week period, sleep data were collected using sleep actigraphy and self-report. Across the entire sample, subjective and objective assessment methods of sleep were strongly correlated, although there were some notable within-group differences. Specifically, although sleep duration between groups did not differ based on actigraphy, veterans without PTSD reported sleeping 1 h and 11 min (p = .002) longer than did veterans with PTSD. In an effort to determine why individuals without PTSD might be overreporting sleep, we found that symptoms of emotional arousal (anger, anxiety, and nightmares) were significantly correlated with self-reported sleep duration, suggesting a pattern of higher autonomic arousal found in veterans with PTSD. Thus, although sleeping for 6 h, the higher levels of emotional arousal reported by veterans with PTSD may mean that they do not perceive their sleep as restful. Further research is necessary to determine if the sleep architecture of veterans with PTSD is actually different from that of combat veterans without PTSD and if such differences are actually amenable to standard behavioral treatments for this disorder.