Addiction as temporal disruption: interoception,self, meaning

Phenomenology and the Cognitive Sciences - Addiction remains a challenging disorder, both to treat and to conceptualise. While the temporal dimension of addiction has been noted before, here the...     

The Worlding of Addiction

Addiction can be partially seen as a worlding; as a lived-out set of ecological relations. Based on existential-phenomenology, the lived-world of the addict is described as a particular way of being in the world. Although attained through active addiction, this way of being endures beyond active addiction into recovery. Active addiction is characterized by narrowness and withdrawal from the world; recovery from addiction entails an embrace of the world. This movement into recovery is described as broadening and reaching out, a way in which the world is opened up to be experienced in all its breadth and spiritual significance. The clinical implications of this perspective are described and explored.     

Maximizing the efficacy of interoceptive exposure by optimizing inhibitory learning: A randomized controlled trial

Cognitive-behavioral treatments for panic disorder (PD) emphasize interoceptive exposure (IE) to target anxiety sensitivity (AS) but vary considerably in its manner of delivery. This randomized controlled trial was conducted to compare the efficacy of the low-dose delivery of IE exercises often prescribed in treatment protocols to an intensive form of IE hypothesized to optimize inhibitory learning. Participants (N = 120) with elevated AS were randomly assigned to one of four single-session interventions: (a) low-dose IE as prescribed in Barlow and Craske's Panic Control Treatment, (b) low-dose IE without controlled breathing or a lengthy between-trial rest period, (c) intensive IE, or (d) expressive writing control. Compared to the other conditions, intensive IE produced significantly greater reductions in AS and fearful responding to a straw breathing task from pretreatment to posttreatment. Maintenance of gains during the follow-up period did not differ between conditions. Changes in fear toleration and negative outcome expectancies fully mediated the superior efficacy of intensive IE over low-dose IE. The two low intensity IE conditions produced particularly high rates of fear sensitization on between-trial and outcome variables. The findings suggest that the intensive delivery of IE exercises has the potential to improve the efficacy of exposure-based treatments for PD.     

The Assessment of Post‐traumatic Stress Disorder for Workers' Compensation in Emergency Service Personnel

There is considerable debate concerning the diagnosis of post‐traumatic stress disorder (PTSD) in compensation claims. This study reviewed the quality of the assessment reports prepared by clinicians who evaluated 31 emergency service workers making PTSD‐related compensation claims. Assessments were conducted by 4‐year trained psychologists (39%), psychologists holding a masters degree (36%), and psychiatrists (19%). The assessment reports were evaluated relative to the diagnostic criteria for PTSD in the Diagnostic and Statistical Manual of Mental Disorders 4th edition (2000). In the majority of cases (81%), the assessor determined that the emergency service worker had PTSD, but only one report met the minimum standard for that diagnosis. In the majority (65%) of cases the clinician failed to address the possibility of malingering. These data suggest that clinical assessment reports for PTSD frequently fail to meet minimum assessment standards.