An open clinical trial of cognitive-behaviour therapy in children and adolescents with obsessive-compulsive disorder administered in regular outpatient clinics

The aim of the present study was to examine the effectiveness of manual-guided cognitive-behaviour therapy (CBT) for childhood obsessive-compulsive disorder (OCD) administered within three regular, i.e., non-academic, Norwegian outpatient child psychiatric clinics. METHODS: A total of 28 youngsters, aged 8-17 with primary OCD entered the study. Assessment at intake included Norwegian versions of the K-SADS-PL, Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and a measure of OCD-specific functional impairment (Child OCD Impact Scale (COIS)). Therapy consisted of 12 manual-guided sessions with combined individual and family CBT-based interventions and was conducted by psychologists and physicians under training and supervision. Outcome was assessed after treatment and at 3- and 6-month follow-ups by means of the CY-BOCS, the Clinical Global Impression (CGI) and the CGI-Improvement scales, and the COIS. RESULTS: Twenty-four youngsters (86%) completed treatment and were available for the follow-up assessments. Significant improvements were found on all outcome measures after treatment, including a mean symptom reduction on the CY-BOCS of 60.6%, increasing to 68.8% at the 6-month follow-up. Estimates of within-group effect sizes showed strong effects of treatment. CONCLUSION: The results of the present study suggest that manual-guided CBT for childhood OCD can be successfully implemented in non-academic community child psychiatric settings with outcomes in accordance with previous findings from highly specialised university clinics.     

Working memory deficit in children with mathematical difficulties: a general or specific deficit?

This study examined whether children with mathematical difficulties (MDs) or comorbid mathematical and reading difficulties have a working memory deficit and whether the hypothesized working memory deficit includes the whole working memory system or only specific components. In the study, 31 10-year-olds with MDs and 37 10-year-olds with both mathematical and reading difficulties were compared with 47 age-matched and 50 younger controls (9-year-olds) on a number of working memory tasks. Compared with the age-matched controls, both groups of children with MDs performed worse on tasks tapping the central executive (e.g., visual matrix span) and the phonological loop (e.g., word span). More important, the MD group performed worse than the younger controls on the counting span task, whereas the group with comorbid mathematical and reading difficulties performed worse on the counting span task and the visual matrix span task. These findings provide support for the assumption that children with MDs have a working memory deficit. More specifically, children with MDs have a central executive deficit connected to concurrent processing and storage of numerical and visual information.     

Personality: a vulnerability factor in rhinitis?

Personality traits were assessed in 63 patients with persistent allergic or non-allergic rhinitis with the Karolinska Scales of Personality, developed with the aim of measuring psychobiological vulnerability factors, and were compared with a reference group comprising a random sample of 400 sex- and age-stratified subjects. The patients' personality profile differed slightly - within one standard deviation - but significantly from the reference group on a number of factors together suggestive of a disinhibitory disposition, an inclination to express anxiety through somatic rather than psychological channels, difficulties in maintaining emotional distance to others, and a limited awareness of aggressive affect, a pattern that suggests that they expose themselves to more stimulation than they can process in terms of thought and feelings, generating sustained physiological arousal that may contribute to the development of their intolerance reactions.     

Internet addiction among Norwegian adults: a stratified probability sample study

Most Norwegians are Internet users. We conducted a stratified probability sample study (Norway, 2007, age-group 16–74 years, N = 3,399, response rate 35.3%, 87.1% Internet users) to assess the prevalence of Internet addiction and at-risk Internet use by the Young Diagnostic Questionnaire (YDQ). The prevalence of Internet addiction (YDQ score 5–8) was 1.0% and an additional 5.2% were at-risk Internet users (YDQ score 3–4). Internet addiction and at-risk Internet use was strongly dependent on gender and age with highest prevalences among young males (16–29 years 4.1% and 19.0%, 30–39 years 3.3% and 10.7%). Logistic regression showed that male gender, young age, university level education, and an unsatisfactory financial situation were factors positively associated with "problematic Internet use" (at-risk and addicted use combined). Time spent on the Internet and prevalence of self-reported sleeping disorders, depression, and other psychological impairments increased linearly with YDQ score. Problematic Internet use clearly affects the lives of many people.     

Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress

Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710 min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients’ in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.     

Using the Internet to provide cognitive behaviour therapy

A new treatment form has emerged that merges cognitive behaviour therapy with the Internet. By delivering treatment components, mainly in the form of texts presented via web pages, and provide ongoing support using e-mail promising outcomes can be achieved. The literature on this novel form of treatment has grown rapidly over recent years with several controlled trials in the field of anxiety disorders, mood disorders and behavioural medicine. For some of the conditions for which Internet-delivered CBT has been tested, independent replications have shown large effect sizes, for example in the treatment of social anxiety disorder. In some studies, Internet-delivered treatment can achieve similar outcomes as in face-to-face CBT, but the literature thus far is restricted mainly to efficacy trials. This article provides a brief summary of the evidence, comments on the role of the therapist and for which patient and therapist this is suitable. Areas of future research and exploration are identified.     

The Experiences of Guilt and Shame: A Phenomenological–Psychological Study

This study aims at discovering the essential constituents involved in the experiences of guilt and shame. Guilt concerns a subject’s action or omission of action and has a clear temporal unfolding entailing a moment in which the subject lives in a care-free way. Afterwards, this moment undergoes a reconstruction, in the moment of guilt, which constitutes the moment of negligence. The reconstruction is a comprehensive transformation of one’s attitude with respect to one’s ego; one’s action; the object of guilt and the temporal-existential experience. The main constituents concerning shame are its anchorage in the situation to which it refers; its public side involving the experience of being perceptually objectified; the exclusion of social community; the bodily experience; the revelation of an undesired self; and the genesis of shame in terms of a history of frozen now-ness. The article ends with a comparison between guilt and shame.     

The utility of the AusEd driving simulator in the clinical assessment of driver fatigue

Several driving simulators have been developed which range in complexity from PC based driving tasks to advanced "real world" simulators. The AusEd driving simulator is a PC based task, which was designed to be conducive to and test for driver fatigue. This paper describes the AusEd driving simulator in detail, including the technical requirements, hardware, screen and file outputs, and analysis software. Some aspects of the test are standardized, while others can be modified to suit the experimental situation. The AusEd driving simulator is sensitive to performance decrement from driver fatigue in the laboratory setting, potentially making it useful as a laboratory or office based test for driver fatigue risk management. However, more research is still needed to correlate laboratory based simulator performance with real world driving performance and outcomes.     

P1198: Software for tracing decision behavior in lending to small businesses

This paper describes a process-tracing software program specially designed to capture decision behavior in lending to small businesses. The source code was written in Lotus Notes. The software runs in a Web browser and consists of two interacting systems: a database and a user interface. The database includes three realistic loan applications. The user interface consists of different but interacting screens that enable the participant to operate the software. Log files registerthe decision behavior of the participant. An empirical example is presented in order to show the software’s potential in providing insights into judgment and decision making. The implications of the software are discussed.