A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

OBJECTIVE: A major problem in the delivery of mental health services is the lack of availability of empirically supported treatment, particularly in rural areas. To date no studies have evaluated the administration of an empirically supported manual-based psychotherapy for a psychiatric condition via telemedicine. The aim of this study was to compare the relative efficacy and acceptability of a manual-based cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) delivered in person to a comparable therapy delivered via telemedicine. METHOD: One hundred twenty-eight adults meeting DSM-IV criteria for BN or eating disorder-not otherwise specified with binge eating or purging at least once per week were recruited through referrals from clinicians and media advertisements in the targeted geographical areas. Participants were randomly assigned to receive 20 sessions of manual-based, CBT for BN over 16 weeks delivered either face-to-face (FTF-CBT) or via telemedicine (TV-CBT) by trained therapists. The primary outcome measures were binge eating and purging frequency as assessed by interview at the end of treatment, and again at 3- and 12-month follow-ups. Secondary outcome measures included other bulimic symptoms and changes in mood. RESULTS: Retention in treatment was comparable for TV-CBT and FTF-CBT. Abstinence rates at end-of-treatment were generally slightly higher for FTF-CBT compared with TV-CBT, but differences were not statistically significant. FTF-CBT patients also experienced significantly greater reductions in eating disordered cognitions and interview-assessed depression. However, the differences overall were few in number and of marginal clinical significance. CONCLUSIONS: CBT for BN delivered via telemedicine was both acceptable to participants and roughly equivalent in outcome to therapy delivered in person.     

Towards effective partnerships in a collaborative problem‐solving task

Background Collaborative learning is recognized as an effective learning tool in the classroom. In order to optimize the collaborative learning experience for children within a collaborative partnership, it is important to understand how to match the children by ability level, and whether assigning roles within these dyads is beneficial or not. Aims The current study investigated the effect of partnering children with different task‐specific abilities and assigning or not assigning helping roles within the dyads on the quality of talk used in a collaborative learning task. Sample The participants in this study comprised 54 year 6 pupils from a Western Sydney government primary school (boys=26, girls=28). The ages ranged from 10 years 10 months to 12 years 4 months with a mean age of 11 years 4 months. Method The children were formed into 27 single sex dyads of low–middle‐ and low–high‐ability partnerships. In half of each of these dyads the higher ability partner was asked to help the lower ability partner, which was compared with just asking partners to work together. The quality of talk used by the dyads while working collaboratively on the problem‐solving task was analysed using a language analysis framework developed by Mercer and colleagues (e.g. Littleton et al., 2005 ; Mercer, 1994, 1996 ). Results Results of this study found that children who worked collaboratively in the low–middle‐ability dyad condition demonstrated significantly more high‐quality exploratory talk than those in the low–high‐ability dyad condition. Although there was no significant difference between dyads who were assigned roles and those who were asked to work together, there was an interaction trend which suggests that low–high‐ability dyads, who were given the roles of helper and learner, showed more exploratory talk than dyads who were asked just to work together. Conclusion Mercer's re‐conceptualization of Vygotsky's Zone of Proximal Development (ZPD) in terms of the Intermental Development Zone (IDZ), which is reliant on constructive challenging discourse, can potentially provide a platform upon which all learners in the classroom can benefit from collaborative learning experiences.     

Tight and loose are not created equal: An asymmetry underlying the representation of fit in English- and Korean-speakers

Research concerning the spatial dimension fit (tight versus loose) has been based on a tacit but untested assumption that the dimension fit is symmetrical, with tight- and loose-fitting relations highlighting the dimension fit with equal force. We propose a reformulation, documenting that adult speakers of English (Experiment 1) and Korean (Experiment 2) are sensitive to the dimension fit, but that their representation is asymmetric, with tight-fitting events highlighting fit with greater force than loose-fitting events. We propose that sensitivity to the dimension fit is more resilient than has previously been suggested, and that the asymmetry documented here provides a foundation upon which to pursue nuanced questions about the relationship between language and our underlying representations of space.     

Differentiating psychotic patients from nonpsychotic patients with the MMPI-2 and Rorschach

The goal of this study was to examine the incremental validity and the clinical utility of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach (Rorschach, 1942) with regard to differential diagnosis in a sample of adult inpatients with a primary psychotic disorder or a primary mood disorder without psychotic features. Diagnostic efficiency statistics have suggested that the Rorschach Perceptual Thinking Index (PTI; Exner, 2000a, 2000b) was better than MMPI-2 scales in discriminating psychotic patients from nonpsychotic patients. We compared the 84% overall correct classification rate (OCC) for the PTI to an OCC of 70% for the MMPI-2 scales. Adding the MMPI-2 scales to the PTI resulted in a decrease in OCC of 1%, whereas adding the PTI to the MMPI-2 resulted in an increase in OCC of 14%. Sensitivity, specificity, positive predictive power, negative predictive power, and kappa were equal or higher with only the PTI in the model.     

Automatic optimism: Biased use of base rate information for positive and negative events

People generally judge that positive events will occur in their lives and negative events will not, even when both events have the same objective likelihood to occur. In four studies, we examined the possibility that this optimistic bias is the result of people’s automatic affective reactions to future events. Studies 1 and 2 demonstrate, in two different contexts, that people are consistently optimistic in their predictions, despite identical base rates for positive and negative events. In Study 2, optimistic bias was not influenced by incentives for motivated reasoning or rewards for accuracy, suggesting that bias was the result of automatic processes. Studies 3 and 4 showed that optimistic bias was more pronounced when predictions were speeded and when participants made predictions after exposure to affectively valenced words. Together, these findings suggest that people optimistically interpret base rates and that this optimism is due to an effortless affective process.     

Interviewees' overuse of the word "like" and hesitations: effects in simulated hiring decisions

This study examined the use of hesitations and discourse markers such as "uh" and "like," sex of an interviewee, and professional or student participants on hiring decisions of job interviewees. Participants consisted of 105 students between the ages of 18 to 43 years and 71 professionals between the ages of 22 to 76 years (120 women, 56 men). Adult professionals and students were least likely to want to hire, perceived the applicant as less professional, and were less likely to recommend the interviewee for hiring if the interviewee overused the word "like" compared to "uh" or control. Professionals were less likely than students overall to want to hire interviewees across conditions. Sex of the interviewee was not found to be significant.     

Visuomotor tracking abilities of speakers with apraxia of speech or conduction aphasia

This investigation examined the visuomotor tracking abilities of persons with apraxia of speech (AOS) or conduction aphasia (CA). In addition, tracking performance was correlated with perceptual judgments of speech accuracy. Five individuals with AOS and four with CA served as participants, as well as an equal number of healthy controls matched by age and gender. Participants tracked predictable (sinusoidal) and unpredictable signals using jaw and lip movements transduced with strain gauges. Tracking performance in participants with AOS was poorest for predictable signals, with decreased kinematic measures of cross-correlation and gain ratio and increased target-tracker difference. In contrast, tracking of the unpredictable signal by participants with AOS was performed as well as for other groups (e.g. participants with CA, healthy controls). Performance of the subjects with AOS on the predictable tracking task was found to strongly correlate with perceptual judgments of speech. These findings suggest that motor control capabilities are impaired in AOS, but not in CA. Results suggest that AOS has its basis in motor programming deficits, not impaired motor execution.     

Amount of training and cue-evoked taste-reactivity responding in reinforcer devaluation

In two experiments, rats received minimal (16) pairings of one auditory conditioned stimulus (CS) cue with a sucrose reinforcer, and extensive (112) pairings of another auditory CS with that reinforcer. After sucrose was devalued by pairing it with lithium chloride in some rats (Devalue groups) but not others (Maintain groups), taste reactivity (TR) and other responses to unflavored water were assessed in the presence of the auditory CSs alone. The minimally trained CS controlled substantially more evaluative TR responses than the extensively trained CS. Those TR responses were hedonic (positive) in the Maintain groups, but aversive (negative) in the Devalue groups. By contrast, food cup entry and other responses thought not to reflect evaluative taste processing were controlled more by the extensively trained cue. These responses were reduced by sucrose devaluation comparably, regardless of the amount of training. The results suggest rapid changes in the content of learning as conditioning proceeds. Early in training, CSs may be capable of activating preevaluative processing of an absent food reinforcer that includes information about its palatability, but that capability is lost as training proceeds.     

Arousal, processing, and risk taking: consequences of intergroup anger

Intergroup emotions theory (IET) posits that when social categorization is salient, individuals feel the same emotions as others who share their group membership. Extensive research supporting this proposition has relied heavily on self-reports of group-based emotions. In three experiments, the authors provide converging evidence that group-based anger has subtle and less explicitly controlled consequences for information processing, using measures that do not rely on self-reported emotional experience. Specifically, the authors show that intergroup anger involves arousal (Experiment 1), reduces systematic processing of persuasive messages (Experiment 2), is moderated by group identification (Experiment 2, posttest), and compared to intergroup fear, increases risk taking (Experiment 3). These findings provide converging evidence that consistent with IET, emotions triggered by social categorization have psychologically consequential effects and are not evident solely in self-reports.