Restlessness in Generalized Anxiety Disorder: Using Actigraphy to Measure Physiological Reactions to Threat

Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable worry accompanied by symptoms of physiological arousal. Although individuals with GAD report greater subjective arousal than healthy individuals, they show equivalent or even attenuated physiological reactions to threat. This may result from using physiological measures better suited to fear than anxiety. To test this possibility, 102 adults with and without GAD were assessed for restlessness, a core physiological symptom of GAD. They were exposed to an in vivo threat task designed to elicit anxiety in the laboratory. Throughout the task, restlessness was measured physiologically with actigraphy sensors on both ankles and both wrists, and subjectively with self-report ratings. The GAD group reported higher subjective restlessness than the no-GAD group, and in the subset of cases who had restlessness as a clinically significant symptom, actigraphy scores were reliably elevated as well. However, although actigraphy scores increased with proximity to the threat, the increases did not differ by group. These findings provide initial validation for actigraphy as a novel measure of motor restlessness in GAD. In addition, they underscore the value of measuring restlessness using multiple assessment methods. These methods suggest that, in GAD, restlessness reflects a chronic state of arousal rather than a heightened physiological reaction to threat.     

How Not to Prove the Existence of ‘Atomless Gunk’

In his ‘Could Extended Objects Be Made Out of Simple Parts?: An Argument for “Atomless Gunk’’, Dean Zimmerman defends the claim that no physical object has a complete decomposition into simples but instead has among its parts a piece of ‘atomless gunk’ His argument for this claim rests in part upon a theory of the impenetrability of physical objects. In that theory, Zimmerman distinguishes ‘[t]he sort of impenetrability that is a part of the concept of’ a physical object from ‘a power to resist the pressure of other objects’. He says that impenetrability is but ‘an essential inability’ of two physical objects to occupy one and the same region of space, an essential inability that is not a power of one physical object to exert repulsive forces on others in its vicinity. I argue that this theory of impenetrability is false and that Zimmerman's argument for the existence of ‘atomless gunk’ fails.     

The effects of “effort after meaning” on recall: Differences in within- and between-subjects designs

In four experiments, we examined free recall of ambiguous sentences with or without corresponding cues to facilitate comprehension, using Auble and Franks’s (1978) paradigm to examine effort after meaning (Bartlett, 1932). The ambiguous sentences were studied without cues, with cues meaningfully embedded in them, with cues provided shortly before the sentence (precue), or with cues following the sentence after several seconds (delayed cue). When these conditions were manipulated within subjects, the process of cue integration in the pre- and delayed-cue conditions enhanced recall, relative to the no-cue and embedded-cue conditions. Furthermore, in a test condition in which subjects first attempted to recall the cues alone, recall was also best in the delayed-cue condition. The effects described above did not occur when the cue presentation conditions varied between subjects, and on a test of order reconstruction, there was even an advantage for sentences studied in the embedded-cue condition over those studied in the delayed-cue condition. The dissociative effects of experimental design on sentence recall and order reconstruction suggest that effort after meaning might enhance memory for study items at the cost of impairing memory for temporal order information.     

Money and distorted ethical judgments about research: ethical assessment of the TeGenero TGN1412 trial

The recent TeGenero phase I trial of a novel monoclonal antibody in healthy volunteers produced a drastic inflammatory reaction in participants receiving the experimental agent. Commentators on the ethics of the research have focused considerable attention on the role of financial considerations: the for-profit status of the biotechnology company and Contract Research Organization responsible respectively for sponsoring and conducting the trial and the amount of monetary compensation to participants. We argue that these financial considerations are largely irrelevant and distort ethical appraisal of this tragic research. Except for administering the antibody to all 6 participants nearly simultaneously, the trial appears to fulfill all of the critical ethical requirements for clinical research--social value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for enrolled participants.     

How children make language out of gesture: morphological structure in gesture systems developed by American and Chinese deaf children

When children learn language, they apply their language-learning skills to the linguistic input they receive. But what happens if children are not exposed to input from a conventional language? Do they engage their language-learning skills nonetheless, applying them to whatever unconventional input they have? We address this question by examining gesture systems created by four American and four Chinese deaf children. The children's profound hearing losses prevented them from learning spoken language, and their hearing parents had not exposed them to sign language. Nevertheless, the children in both cultures invented gesture systems that were structured at the morphological/word level. Interestingly, the differences between the children's systems were no bigger across cultures than within cultures. The children's morphemes could not be traced to their hearing mothers' gestures; however, they were built out of forms and meanings shared with their mothers. The findings suggest that children construct morphological structure out of the input that is handed to them, even if that input is not linguistic in form.     

The Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A): Development of an Instrument for the Assessment of “Focused” and “Automatic” Hair Pulling

This article describes the development of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A), which was designed to assess “automatic” and “focused” pulling subtypes of trichotillomania (TTM). Participants reporting symptoms of TTM (n = 1,697) completed an internet survey; participants were later randomly assigned to either Exploratory (n = 848) or Confirmatory (n = 849) Analyses. Exploratory Analyses examined the development and psychometric properties of the MIST-A. Results of an exploratory factor analysis revealed a two-factor solution. Factor 1 (“focused” pulling scale) and 2 (“automatic” pulling scale) consisted of ten and five items respectively, with both scales demonstrating adequate internal consistency and good construct and discriminant validity. Subsequent confirmatory factor analysis demonstrated support for the scale’s underlying factor structure. The MIST-A provides researchers with a reliable and valid assessment of “automatic” and “focused” pulling, although replication using a clinically ascertained sample is necessary.

Adding motivational interviewing to exposure and ritual prevention for obsessive-compulsive disorder: an open pilot trial

Exposure and ritual prevention (EX/RP) is an efficacious treatment for obsessive-compulsive disorder (OCD), but high dropout rates and variable treatment adherence limit its effectiveness. Motivational interviewing (MI) has shown promise as an adjunct to symptom-focused treatments for improving treatment adherence and outcomes. The authors developed a manual integrating MI with EX/RP, consisting of three information-gathering/motivational enhancement sessions and 15 EX/RP sessions with an optional MI module to be used as needed. Six patients with moderate to severe OCD symptoms (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score> or =16) underwent treatment. Five showed a decrease in their baseline Y-BOCS scores and an increase in their quality of life, with three achieving an excellent response (i.e. Y-BOCS< or =12 at Session 18). The authors briefly describe the motivational strategies used in the six cases and suggest that integrating MI with standard EX/RP is a promising method to increase and sustain patient engagement with EX/RP. Challenges in combining these treatments and maintaining the integrity of each as well as limitations of the study are discussed.