Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

Internal health locus of control predicts willingness to track health behaviors online and with smartphone applications

Given rising technology use across all demographic groups, digital interventions offer a potential strategy for increasing access to health information and care. Research is lacking on identifying individual differences that impact willingness to use digital interventions, which may affect patient engagement. Health locus of control, the amount of control an individual believes they have over their own health, may predict willingness to use mobile health (mHealth) applications (‘apps’) and online trackers. A cross-sectional study (n = 276) was conducted to assess college students’ health locus of control beliefs and willingness to use health apps and online trackers. Internal and powerful other health locus of control beliefs predicted willingness to use health apps and online trackers while chance health locus of control beliefs did not. Individuals with internal and powerful other health locus of control beliefs are more willing than those with chance health locus of control beliefs to utilize a form of technology to monitor or change health behaviors. Health locus of control is an easy-to-assess patient characteristic providers can measure to identify which patients are more likely to utilize mHealth apps and online trackers.     

Escape from rich‐to‐lean transitions: Stimulus change and timeout

Extended pausing during discriminable transitions from rich‐to‐lean conditions can be viewed as escape (i.e., rich‐to‐lean transitions function aversively). In the current experiments, pigeons’ key pecking was maintained by a multiple fixed‐ratio fixed‐ratio schedule of rich or lean reinforcers. Pigeons then were provided with another, explicit, mechanism of escape by changing the stimulus from the transition‐specific stimulus used in the multiple schedule to a mixed‐schedule stimulus (Experiment 1) or by producing a period of timeout in which the stimulus was turned off and the schedule was suspended (Experiment 2). Overall, escape was under joint control of past and upcoming reinforcer magnitudes, such that responses on the escape key were most likely during rich‐to‐lean transitions, and second‐most likely during lean‐to‐lean transitions. Even though pigeons pecked the escape key, they paused before doing so, and the latency to begin the fixed ratio (i.e., the pause) remained extended during rich‐to‐lean transitions. These findings suggest that although the stimulus associated with rich‐to‐lean transitions functioned aversively, pausing is more than simply escape responding from the stimulus.     

What's Context Got to Do with It? Comparative Difficulty of Test Questions Influences Metacognition and Corrected Scores for Formula‐scored Exams

Summary: On formula‐scored exams students receive points and penalties for correct and incorrect answers, respectively, but they can avoid the penalty by withholding incorrect answers. However, test‐takers have difficulty strategically regulating their accuracy and often set an overly conservative metacognitive response bias (e.g., Higham, 2007). The current experiments extended these findings by exploring whether the comparative difficulty of surrounding test questions (i.e., easy vs. hard)—a factor unrelated to the knowledge being tested—impacts metacognitive response bias for medium‐difficulty test questions. Comparative difficulty had no significant influence on participants' ability to choose correct answers for medium questions, but it did affect willingness to report answers and confidence ratings. This difference carried over to corrected scores (scores after penalties are applied) when comparative difficulty was manipulated within‐subjects: Scores were higher in the hard condition. Results are discussed in terms of implications for interpreting formula‐scored tests and underlying mechanisms of performance.Copyright © 2017 John Wiley & Sons, Ltd.     

Repressive coping and cardiovascular reactivity to novel and recurrent stress

Background and objectives: Repressors tend to report less negative emotion and to describe challenges as less stressful, yet tend to exhibit higher rates of cardiovascular disease. While repressive coping has been shown to be associated with exaggerated physiological reactivity to novel stress, we sought to establish if elevated responses persisted across repeated exposure.

Design and methods: In a sample of 86 healthy female adults, a verbal-autonomic response dissociation index of repressive coping was computed. Participants were exposed to two consecutive stress tasks, with analyses based on comparisons of consecutive stress responses.

Results: Analysis of covariance demonstrated significant differences across the study on diastolic blood pressure and cardiac output, as a function of repressive coping. Repressors showed elevated reactions to both stress tasks; however, cardiac output responses to the second task were more muted indicating that repressive coping was associated with successful adaptation to recurrent stress. Nevertheless, repressive copers maintained an exaggerated cardiovascular responses to recurrent stress.

Conclusions: The present study identifies that repressive coping may be associated with increased risk of cardiovascular disease development through elevated cardiovascular reactions to both novel and recurrent stress.     

Motor planning and execution in left- and right-handed individuals during a bimanual grasping and placing task

The issue of handedness has been the topic of great interest for researchers in a number of scientific domains. It is typically observed that the dominant hand yields numerous behavioral advantages over the non-dominant hand during unimanual tasks, which provides evidence of hemispheric specialization. In contrast to advantages for the dominant hand during motor execution, recent research has demonstrated that the right hand has advantages during motor planning (regardless of handedness), indicating that motor planning is a specialized function of the left hemisphere. In the present study we explored hemispheric advantages in motor planning and execution in left- and right-handed individuals during a bimanual grasping and placing task. Replicating previous findings, both motor planning and execution was influenced by object end-orientation congruency. In addition, although motor planning (i.e., end-state comfort) was not influenced by hand or handedness, motor execution differed between left and right hand, with shorter object transport times observed for the left hand, regardless of handedness. These results demonstrate that the hemispheric advantages often observed in unimanual tasks do not extend to discrete bimanual tasks. We propose that the differences in object transport time between the two hands arise from overt shifting visual fixation between the two hands/objects.     

Recollection is impaired by the modification of interpretation bias

The interpretation paradigm of cognitive-bias modification (CBM-I) was modified with instructions used in process-dissociation procedures for the purpose of investigating processes contributing to performance on the transfer task. In Experiment 1, nonanxious students were trained to interpret ambiguous situations in either a negative or benign way (or they read nonambiguous scenarios). They were then asked to respond to new ambiguous situations, in the same way as contextually similar analogues during training, or to respond differently. Benign training proactively impaired memory for negative outcomes. This effect was replicated by anxious students in Experiment 2 and discussed with respect to the assumptions underlying process-dissociation procedures and directions for future research.     

The processing of auditory and visual recognition of self-stimuli

This study examined self-recognition processing in both the auditory and visual modalities by determining how comparable hearing a recording of one’s own voice was to seeing photograph of one’s own face. We also investigated whether the simultaneous presentation of auditory and visual self-stimuli would either facilitate or inhibit self-identification. Ninety-one participants completed reaction-time tasks of self-recognition when presented with their own faces, own voices, and combinations of the two. Reaction time and errors made when responding with both the right and left hand were recorded to determine if there were lateralization effects on these tasks. Our findings showed that visual self-recognition for facial photographs appears to be superior to auditory self-recognition for voice recordings. Furthermore, a combined presentation of one’s own face and voice appeared to inhibit rather than facilitate self-recognition and there was a left-hand advantage for reaction time on the combined-presentation tasks.     

Don’t Ever Do That! Long-term Duties in <Emphasis Type="Italic">PD</Emphasis><Subscript><Emphasis Type="Italic">e</Emphasis></Subscript><Emphasis Type="Italic">L</Emphasis>

This paper studies long-term norms concerning actions. In Meyer’s Propositional Deontic Logic (PD _e L), only immediate duties can be expressed, however, often one has duties of longer durations such as: “Never do that”, or “Do this someday”. In this paper, we will investigate how to amend PD _e L so that such long-term duties can be expressed. This leads to the interesting and suprising consequence that the long-term prohibition and obligation are not interdefinable in our semantics, while there is a duality between these two notions. As a consequence, we have provided a new analysis of the long-term obligation by introducing a new atomic proposition I (indebtedness) to represent the condition that an agent has some unfulfilled obligation. Presented by Jacek Malinowski