The Relationship Between Dropout and Outcome in Naturalistic Cognitive Behavior Therapy

Dropout from psychotherapy is frequent and limits the benefits patients can receive from treatment. The study of factors associated with dropout has the potential to yield strategies to reduce it. This study analyzed data from a large sample of adults (N = 1,092) receiving naturalistic cognitive behavioral therapy (CBT) to test the hypotheses that dropouts, as compared to completers, had (1) higher symptom severity at treatment termination, (2) a slower rate of symptom change during treatment, and (3) a higher odds that the therapist rated treatment as ending for reasons related to poor outcome. Results showed that although dropouts ended treatment with higher symptom severity than completers, dropouts and completers did not differ in their rate of symptom change during treatment, suggesting that dropouts had higher symptom severity at termination because they received fewer sessions of treatment, not because their symptoms changed at a slower rate. Dropout was also associated with a higher odds of having a therapist-rated termination reason indicating a poor outcome, suggesting that dropout is more likely if patients are dissatisfied with some aspect of the therapy outcome or process. These findings suggest that strategies for monitoring and enhancing patient satisfaction with the process and outcome of treatment may help patients stay in treatment longer and end treatment with fewer symptoms than if they had dropped out.     

Forgiving the September 11th terrorists: associations with coping, psychological distress, and religiosity

Two studies examined how non-interpersonal forgiveness (when there is no social relationship between the transgressor and forgiver) related to coping and involuntary responses to stress, psychological distress, and religiosity. Three to six weeks after September 11th, 2001, forgiveness had non-linear associations with other responses to the terrorist attacks. Among college students (N=488), those who were trying or had forgiven (pro-forgiveness) the terrorists reported less involuntary engagement, more primary and secondary control coping, and more meaning finding than those who were unsure about forgiveness (ambivalent) and those who did not believe the perpetrators should be forgiven (anti-forgiveness). Ambivalent students reported the most distress, even after controlling for religion. Anti-forgiveness students reported less religiosity than ambivalent and pro-forgiveness students. Most findings were consistent among middle schoolers (N=154), particularly regarding psychological distress and responses to stress. Also, forgiveness of strangers for acts against one's community functioned separately from religion.     

A terminal diagnosis: The carers’ perspective

This qualitative study explored the views of spouse carers in relation to the emotional impact of caring for a partner with a chronic or terminal illness. The study population consisted of nine full‐time spouse carers, recruited using a snowball sampling strategy. Semi‐structured interviews took place in the carers’ homes. These were recorded and transcribed verbatim. The data were then analysed using constant comparative analysis. Themes identified included the emotional and physical health of the carer, personality changes in the spouse, relationship issues, denial, anticipating death, accessing support and coping strategies. Findings indicate that these carers experienced a whole range of feelings and emotions, which impacted on their health and well‐being. They included fatigue, stress, distress, anxiety, depression, feelings of isolation and suicidal thoughts. These were particularly profound around the time of diagnosis, end of treatment, during a relapse and most particularly around the time of death. An increasing number of terminally ill people are now expressing a preference to be cared for at home. The potential risks to the health of caregivers therefore need to be taken into account. This study highlights the importance of assessing the needs of carers in order to identify those at risk of compromised health, which would then allow those requiring support to be offered prompt referral to specialist services.     

Interpersonal perception and personality disorders: Utilization of a thin slice approach

Study 1 expands upon previous research by looking at the ability of untrained raters to detect pathological traits within a normal population of college students. In Study 1, 30-s video clips of 81 target persons were shown to 42 raters. Ratings of traits of personality disorders made by thin slice raters reliably predicted scores on the personality pathology measures obtained from the targets themselves and from close peers. Study 2 is a preliminary examination of how pathological rater traits impacts thin slice accuracy. In Study 2, peer and self-report data were examined regarding 87 thin slice raters. Raters who exhibited traits of narcissistic personality disorder were significantly less accurate in making personality predictions regarding targets. Three clusters of personality items were identified based on rater characteristics related to accuracy in predicting behavior.     

The effectiveness of function‐based interventions to treat sleep problems,including unwanted co‐sleeping,in children with autism

This study investigated the effectiveness of functional behavioral assessment (FBA)—informed interventions for sleep problems, particularly co‐sleeping, in children with autism spectrum disorder (ASD). Seven children, who exhibited multiple sleep problems including unwanted co‐sleeping, participated. FBA, based on information derived from interviews and parent‐recorded sleep diaries, was used to develop individualized case formulations upon which multicomponent, parent‐implemented interventions were based. These were evaluated using a single‐case, non‐concurrent multiple‐baseline‐across‐participants design. Improvements were observed across all sleep problems, including the elimination of co‐sleeping. Gains were maintained at follow‐up for five out of seven children, though two children did not complete intervention. Parents reported high levels of satisfaction with the program. FBA‐based interventions for sleep problems in children with ASD and their clinical implications are further discussed.     

α7 Nicotinic Receptor Subunits Are Not Necessary for Hippocampal-Dependent Learning or Sensorimotor Gating: A Behavioral Characterization of Acra7-Deficient Mice

The α7 nicotinic acetylcholine receptor (nAChR) subunit is abundantly expressed in the hippocampus and contributes to hippocampal cholinergic synaptic transmission suggesting that it may contribute to learning and memory. There is also evidence for an association between levels of α7 nAChR and in sensorimotor gating impairments. To examine the role of α7 nAChRs in learning and memory and sensorimotor gating, Acra7 homozygous mutant mice and their wild-type littermates were tested in a Pavlovian conditioned fear test, for spatial learning in the Morris water task, and in the prepulse inhibition paradigm. Exploratory activity, motor coordination, and startle habituation were also evaluated. Acra7 mutant mice displayed the same levels of contextual and auditory-cue condition fear as wild-type mice. Similarly, there were no differences in spatial learning performance between mutant and wild-type mice. Finally, Acra7 mutant and wild-type mice displayed similar levels of prepulse inhibition. Other behavioral responses in Acra7 mutant mice were also normal, except for an anxiety-related behavior in the open-field test. The results of this study show that the absence of α7 nAChRs has little impact on normal, base-line behavioral responses. Future studies will examine the contribution of α7 nAChR to the enhancement of learning and sensorimotor gating following nicotine treatments.     

The shared leadership process in decision-making teams

The present study examined the process of shared leadership in 45 ad hoc decision-making teams. Each team member's leadership behavior (n = 180) was assessed by behaviorally coding videotapes of the teams' discussions. The within-team patterns of leadership behavior were examined using cluster analysis. Results indicated that the likelihood of a team experiencing a full range of leadership behavior increased to the extent that multiple team members shared leadership, and that teams with shared leadership experienced less conflict, greater consensus, and higher intragroup trust and cohesion than teams without shared leadership. This study supports previous findings that shared leadership contributes to overall team functioning, and begins to delineate the extent to which team members may naturally share leadership.     

Validation of Self-Report Impairment Measures for Section III Obsessive–Compulsive and Avoidant Personality Disorders

This study examined the validity of newly developed disorder-specific impairment scales (IS), modeled on the Level of Personality Functioning Scale, for obsessive–compulsive (OCPD) and avoidant (AvPD) personality disorders. The IS focused on content validity (items directly reflected the disorder-specific impairments listed in DSM-5 Section III) and severity of impairment. A community sample of 313 adults completed personality inventories indexing the DSM-5 Sections II and III diagnostic criteria for OCPD and AvPD, as well as measures of impairment in the domains of self- and interpersonal functioning. Results indicated that both impairment measures (for AvPD in particular) showed promise in their ability to measure disorder-specific impairment, demonstrating convergent validity with their respective Section II counterparts and discriminant validity with their noncorresponding Section II disorder and with each other. The pattern of relationships between scores on the IS and scores on external measures of personality functioning, however, did not indicate that it is useful to maintain a distinction between impairment in the self- and interpersonal domains, at least for AvPD and OCPD.     

Alcohol Intoxication and Metamemory: Little Evidence that Moderate Intoxication Impairs Metacognitive Monitoring Processes

There is minimal research on metacognition in alcohol‐intoxicated participants. Study 1 examined metacognition across sober, intoxicated, and placebo groups, with the intoxicated group's breath alcohol concentration reaching 0.074 g/210 L on average immediately prior to the metacognition task. Participants answered cued recall general knowledge questions and provided confidence ratings and feeling‐of‐knowing judgments. They then completed a recognition (i.e., multiple choice) version of the same task, indicating an answer and a confidence rating for each question. Findings suggest that metacognitive accuracy generally did not vary across intoxication levels, although the control group's retrospective confidence judgments better discriminated between accurate and inaccurate responses than the alcohol groups in the recognition task. Study 2 surveyed academic psychologists about their expectations regarding the relation between alcohol and metacognition. Study 1's results were counter to their expectations, as respondents generally predicted a relation would be present. We discuss the implications for alcohol and memory.Copyright © 2017 John Wiley & Sons, Ltd.