An Intensive Outpatient Program for Veterans With Posttraumatic Stress Disorder and Traumatic Brain Injury

Post-9/11 service members may return from military service with a complicated set of symptoms and conditions, such as posttraumatic stress disorder (PTSD), depression, substance misuse, and traumatic brain injury (TBI), that interfere with reintegration and impair functioning. Although evidence-based treatments that facilitate recovery exist, their successful delivery at a sufficient dose is limited. Barriers to accessing treatment combined with challenges compiling a comprehensive treatment team further delay delivery of effective evidence-based care for PTSD, TBI, and co-occurring mental health conditions. This paper describes the development of a comprehensive, multidisciplinary, 2-week intensive day program for post-9/11 veterans with complex mental health concerns. The treatment program combines skill building groups, family education, and integrative health approaches with evidence-based individual PTSD or TBI care. Initial results from the first 132 participants were notable for a 97% completion rate, as well as statistically significant and clinically meaningful reductions in PTSD, neurobehavioral, and depression symptom severity for the 107 veterans who completed the PTSD track and the 21 who completed the TBI track. These data suggest the intensive program approach is an effective, well-tolerated model of treatment for post-9/11 veterans with PTSD and/or TBI. Future controlled studies should examine the effectiveness of this intensive model compared to standard evidence-based therapy delivery, as well as longitudinal outcomes.     

Parental coping socialization is associated with healthy and anxious early‐adolescents’ neural and real‐world response to threat

The ways parents socialize their adolescents to cope with anxiety (i.e., coping socialization) may be instrumental in the development of threat processing and coping responses. Coping socialization may be important for anxious adolescents, as they show altered neural threat processing and over reliance on disengaged coping (e.g., avoidance and distraction), which can maintain anxiety. We investigated whether coping socialization was associated with anxious and healthy adolescents’ neural response to threat, and whether neural activation was associated with disengaged coping. Healthy and clinically anxious early adolescents (N = 120; M = 11.46 years; 71 girls) and a parent engaged in interactions designed to elicit adolescents’ anxiety and parents’ response to adolescents’ anxiety. Parents’ use of reframing and problem solving statements was coded to measure coping socialization. In a subsequent visit, we assessed adolescents’ neural response to threat words during a neuroimaging task. Adolescents’ disengaged coping was measured using ecological momentary assessment. Greater coping socialization was associated with lower anterior insula and perigenual cingulate activation in healthy adolescents and higher activation in anxious adolescents. Coping socialization was indirectly associated with less disengaged coping for anxious adolescents through neural activation. Findings suggest that associations between coping socialization and early adolescents’ neural response to threat differ depending on clinical status and have implications for anxious adolescents’ coping.     

A longitudinal investigation of stress spillover in marriage: does spousal support adequacy buffer the effects?

Stress spillover in marriage was examined within a stress-buffering conceptual framework in a multiwave, longitudinal sample of newlywed husbands and wives (N = 101 couples). Spousal support, chronic role strain, and marital satisfaction were assessed 4 times over 3 years and analyzed via actor-partner interdependence model and growth curve analytic techniques. Greater escalation in husbands' role strain over the first 3 years of marriage was associated with steeper declines in their marital satisfaction regardless of the adequacy of spousal support provided by their wives. In contrast, greater escalation in husbands' and wives' role strain was associated with significantly less marital decline for wives, and these links were bolstered when husbands provided wives with more adequate support. The present study is one of the first to explicate the underlying processes through which role strain and spousal support facilitate and mitigate the developmental course of marital satisfaction.     

Marital satisfaction across the transition to parenthood.

The purpose of the present study was to discriminate between the 2 dominant perspectives governing research on the nature of marital change over the transition to parenthood. Progress can be made in understanding this transition by recognizing the role of uncontrolled sources of variability in research designs, defining and using control groups, and timing of data collection around the child's arrival, and the authors conducted a study incorporating these methodological refinements. Growth curve analyses were conducted on marital satisfaction data collected twice before and twice after the birth of the 1st child and at corresponding points for voluntarily childless couples (N = 156 couples). Spouses who were more satisfied prior to pregnancy had children relatively early in marriage, and parents experienced greater declines in marital satisfaction compared to nonparents. Couples with planned pregnancies had higher prepregnancy satisfaction scores, and planning slowed husbands' (but not wives') postpartum declines. In sum, parenthood hastens marital decline--even among relatively satisfied couples who select themselves into this transition--but planning status and prepregnancy marital satisfaction generally protect marriages from these declines.     

Event-related potential correlates of interference effects on recognition memory

The question of interference (how new learning affects previously acquired knowledge and vice versa) is a central theoretical issue in episodic memory research, but very few human neuroimaging studies have addressed this question. Here, we used event-related potentials (ERPs) to test the predictions of the complementary learning systems (CLS) model regarding how list strength manipulations (strengthening some, but not all, items on a study list) affect recognition memory. Our analysis focused on the FN400 old-new effect, a hypothesized ERP correlate of familiarity-based recognition, and the parietal old-new effect, a hypothesized ERP correlate of recollection-based recognition. As is predicted by the CLS model, increasing list strength selectively reduced the ERP correlate of recollection-based discrimination, leaving the ERP correlate of familiarity-based discrimination intact. In a second experiment, we obtained converging evidence for the CLS model’s predictions, using a remember/know test: Increasing list strength reduced recollection-based discrimination but did not reduce familiarity-based discrimination.     

Introduction to ``Vulnerability' Issues of Theretical Medicine and Bioethics

Theoretical Medicine and Bioethics -     

Identifying unreliable informants: do children excuse past inaccuracy?

In three experiments (N = 123; 148; 28), children observed a video in which two speakers offered alternative labels for unfamiliar objects. In Experiment 1, 3‐ to 5‐year‐olds endorsed the label given by a speaker who had previously labeled familiar objects accurately, rather than that given by a speaker with a history of inaccurate labeling, even when the inaccurate speaker erred only while blindfolded. In Experiments 2 and 3, 3‐ to 7‐year‐olds showed no preference for the label given by a previously inaccurate but blindfolded speaker, over that given by a second inaccurate speaker with no obvious excuse for erring. Children based their endorsements on speakers’ history of accuracy or inaccuracy irrespective of the speakers’ information access at the time, raising doubts that children made mentalistic interpretations of speakers’ inaccuracy.     

Working memory and inhibitory control across the life span: Intrusion errors in the Reading Span Test

The aim of this study was to examine to what extent inhibitory control and working memory capacity are related across the life span. Intrusion errors committed by children and younger and older adults were investigated in two versions of the Reading Span Test. In Experiment 1, a mixed Reading Span Test with items of various list lengths was administered. Older adults and children recalled fewer correct words and produced more intrusions than did young adults. Also, age-related differences were found in the type of intrusions committed. In Experiment 2, an adaptive Reading Span Test was administered, in which the list length of items was adapted to each individual’s working memory capacity. Age groups differed neither on correct recall nor on the rate of intrusions, but they differed on the type of intrusions. Altogether, these findings indicate that the availability of attentional resources influences the efficiency of inhibition across the life span.