Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.     

Leader power and leader self-serving behavior: The role of effective leadership beliefs and performance information

In this research we investigated the role played by leader power in determining leader self-serving behavior. Based on an integration of insights from research on the determinants of leader behavior and the power-approach theory, we hypothesized that with higher leader power leader self-serving behavior is determined more by internal states like effective leadership beliefs and less by external cues like performance information. We found support for this prediction across two experiments and one organizational survey assessing leader behavior along a self-serving–group-serving continuum. Overall, these results suggest that whether leaders benefit the collective or act self-servingly is not a function of their power per se but rather that leader power determines the extent to which internal belief states or external cues influence leader self- versus group-serving behavior.     

Strategic grouping in the spatial span memory task

Spatial short-term memory performance was examined in relation to participants’ strategies. A total of 20 adult participants viewed and reproduced sequences of locations that varied in length (five, six, seven, or eight locations) and spatial separability (a manipulation of the configurations). In trial-by-trial self-reports, participants described five types of strategies. Chunking the spatial sequences into groups of three or four locations was the sole strategy associated with increased accuracy. Participants demonstrated considerable variability in the strategies that they selected, suggesting that cognitive resources are allocated to strategy selection, execution, and monitoring in the spatial span task. Spatially separable sequences were more accurately recalled than nonseparable sequences, independent of strategic grouping, suggesting two levels of grouping in the spatial span task.     

“They Go Too Far”: Reply to Review Essays by Lewes and O'Connor

Kenneth Lewes and Noreen O'Connor share little common ground in their discussions of Lesbian Lives. They agree that it represents, in Lewes's words, “important trends in psychoanalysis and more general intellectual discourse” (“the developing discourse on homosexuality, the ascendancy of feminist ideas within psychoanalysis, … the shift … from classical drive theory to … more … relational approaches, and the influence of postmodern social and literary thought”). But whereas O'Connor welcomes a text she sees as offering “critiques of traditional psychoanalysis's binary theorising of gender and sexuality,” Lewes finds that Lesbian Lives presents “certain questions and difficulties, especially to those who, like myself, espouse theoretical and political allegiances quite different from them.” This article responds to several of Lewes's distortions and misreadings, including his allegations that the authors believe they can “conduct therapy without theory or value” and that they “insist on the essential sameness of people who are heterosexual and homosexual.” Lewes also wrongly attributes to the authors a simplistic belief in “sexual fluidity” and the “multiplicity of selves.” Instead, the text of Lesbian Lives in various ways encourages psychoanalysis to incorporate into its developmental models what it has learned clinically about the multiple dimensions of subjective experience.     

Transference Focused Psychotherapy for Patients with Comorbid Narcissistic and Borderline Personality Disorder

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment.     

Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

Depression during the prenatal and postpartum periods is associated with poor maternal, perinatal and child outcomes. This study examines the effectiveness of a culturally and linguistically tailored, social support-based, healthy lifestyle intervention led by trained community health workers in reducing depressive symptoms among pregnant and early postpartum Latinas. A sample of 275 pregnant Latinas was randomized to the Healthy MOMs Healthy Lifestyle Intervention (MOMs) or the Healthy Pregnancy Education (control) group. More than one-third of participants were at risk for depression at baseline. MOMs participants were less likely than control group participants to be at risk for depression at follow-up. Between baseline and 6 weeks postpartum, MOMs participants experienced a significant decline in depressive symptoms; control participants experienced a marginally significant decline. For MOMs participants, most of this decline occurred during the pregnancy intervention period, a time when no change occurred for control participants. The change in depressive symptoms during this period was greater among MOMs than control participants (“intervention effect”). From baseline to postpartum, there was a significant intervention effect among non-English-speaking women only. These findings provide evidence that a community-planned, culturally tailored healthy lifestyle intervention led by community health workers can reduce depressive symptoms among pregnant, Spanish-speaking Latinas.     

Short-Term Memory and Working Memory in Children with Blindness: Support for a Domain General or Domain Specific System?

The study explored the contribution of two component processes (phonological and executive) to blind children's memory performance. Children with blindness and sight were matched on gender, chronological age, and verbal intelligence and compared on measures of short-term memory (STM) and working memory (WM). Although the measures were highly correlated, the results from two experiments indicated that the blind children were superior to sighted children on measures of STM, but not on measures of WM. The results supported the notion that children with blindness have advantages on memory tasks that draw upon resources from the phonological loop. However, comparable performance between the ability groups on WM measures suggests there are domain specific aspects in the executive system.     

Fracture mechanisms of symmetrical tilt grain boundaries

The mechanisms of failure of symmetrical tilt boundaries have been investigated using an atomistic technique. The fracture process advances in steps that are related to the structural unit of the symmetrical tilt grain boundary. These boundaries are shown to fail through a combined mechanism involving dislocation emission in certain regions of the structural unit, followed by microcleavage, and again dislocation emission. The overall toughness of the boundaries is given by the combination of the toughness of these two processes.     

Elaboration and Autonomy Support in Low-Income Mothers' Reminiscing: Links to Children's Autobiographical Narratives

Maternal elaboration and autonomy support during reminiscing facilitate middle-class children's autobiographical narrative skills. In this study, low-income Hispanic, White, and Black mothers' elaboration and autonomy support in reminiscing were examined in relation to children's joint and independent autobiographical narratives and engagement. Sixty preschool children discussed three past events with their mothers and one past event with a researcher. Maternal elaboration was related to children's joint and independent autobiographical narratives, and autonomy support was related to children's joint and independent engagement. Hispanic mothers used a less elaborative style during conversations about misbehavior, and Hispanic children tended to have less advanced independent autobiographical narratives. Maternal elaboration and autonomy support appear to play different roles in children's autobiographical narratives. Further, reminiscing may serve different purposes in different racial/ethnic groups.     

The Role of Attachment Style and Depression in Patients with Hepatitis C

Patients infected with chronic hepatitis C virus (HCV) commonly suffer from the triad of depression, pain and fatigue. This symptom triad in HCV is likely influenced by additional psychological and interpersonal factors, although the relationship is not clearly understood. This retrospective study aimed to characterize the relationship between attachment style and depressive and physical symptoms in the HCV-infected population. Over 18 months, 99 consecutively referred HCV infected patients were assessed with the Hamilton Depression Rating Scale (HDRS), Fatigue Severity Scale, Patient Health Questionnaire-15 for physical symptoms and the Relationship Questionnaire for attachment style. An ANOVA was used to identify differences between attachment styles and Pearson correlations were used to evaluate the association between depression, fatigue and physical symptoms. Approximately 15 % of patients in the sample had a fearful attachment style. Patients with fearful attachment style had significantly higher depressive symptoms compared to a secure attachment style (p = .025). No differences in physical and fatigue symptoms were observed between attachment styles. Further, HDRS scores were significantly associated with fatigue scores (p < .001) and physical symptoms (p < .001), reinforcing the relationship between these symptom domains in HCV-infected patients. Although depressive, physical and fatigue symptoms are inter-related in HCV-infected patients, our study results suggest that only depressive symptoms were influenced by the extremes of attachment style. Screening of relationship styles may identify at-risk HCV-infected individuals for depression who may have difficulty engaging in care and managing physical symptoms.