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.     

Online "predators" and their victims: myths, realities, and implications for prevention and treatment

The publicity about online "predators" who prey on naive children using trickery and violence is largely inaccurate. Internet sex crimes involving adults and juveniles more often fit a model of statutory rape--adult offenders who meet, develop relationships with, and openly seduce underage teenagers--than a model of forcible sexual assault or pedophilic child molesting. This is a serious problem, but one that requires approaches different from those in current prevention messages emphasizing parental control and the dangers of divulging personal information. Developmentally appropriate prevention strategies that target youths directly and acknowledge normal adolescent interests in romance and sex are needed. These should provide younger adolescents with awareness and avoidance skills while educating older youths about the pitfalls of sexual relationships with adults and their criminal nature. Particular attention should be paid to higher risk youths, including those with histories of sexual abuse, sexual orientation concerns, and patterns of off- and online risk taking. Mental health practitioners need information about the dynamics of this problem and the characteristics of victims and offenders because they are likely to encounter related issues in a variety of contexts.     

Familial patterns and the origins of individual differences in synaesthesia

The term synaesthesia has been applied to a range of different sensory-perceptual and cognitive experiences, yet how these experiences are related to each other is not well understood. Not only are there disparate types of synaesthesia, but even within types there are vast individual differences in the way that stimuli induce synaesthesia and in the subjective synaesthetic experience. An investigation of the inheritance patterns of different types of synaesthesia is likely to elucidate whether a single underlying mechanism can explain all types. This study is the first to systematically survey all types of synaesthesia within a familial framework. We recruited 53 synaesthetes and 42% of these probands reported a first-degree relative with synaesthesia. We then directly contacted as many first-degree relatives as possible and collected complete data on synaesthetic status for all family members for 17 families. We found that different types of synaesthesia can occur within the same family and that the qualitative nature of the experience can differ between family members. Our findings strongly indicate that various types of synaesthesia are fundamentally related at the genetic level, but that the explicit associations and the individual differences between synaesthetes are influenced by other factors. Synaesthesia thus provides a good model to explore the interplay of all these factors in the development of cognitive traits in general.     

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.     

The relationship between impulsive verbal aggression and intermittent explosive disorder

Intermittent explosive disorder (IED) is the sole psychiatric diagnostic category for which aggression is a cardinal symptom. IED focuses on physical aggression, but researchers have argued for the inclusion of verbal aggression (VA) (e.g., arguing, threatening) as a part of the IED criteria set. The utility of VA in identifying clinically relevant aggression, however, is unknown. IED participants were compared to individuals without a marked history of physical aggression, but who report frequent (two or more times a week) VA, and non-aggressive personality-disorder individuals on behavioral and self-report measures of aggression, self-report measures of related constructs (e.g., anger, affective lability), and a clinician assessment of psychosocial impairment. Both the IED and VA groups were more aggressive, angry, and clinically impaired than personality-disorder individuals, while the IED and VA groups did not differ from each other on these measures. These results support the clinical importance of frequent VA for future iterations of the IED criteria set.     

Analysis of the role of associative inhibition in perceptual learning by means of the same-different task

In Experiment 1a, participants were exposed, over a series of trials, to separate presentations of 2 similar checkerboard stimuli, AX and BX (where X represents a common background). In one group, AX and BX were presented on alternating trials (intermixed), in another, they were presented in separate blocks of trials (blocked). The intermixed group performed to a higher standard than the blocked group on a same-different test. A superiority of intermixed over blocked exposure was also evident in a within-subject design (Experiment 1b) and when the test required discrimination between a preexposed stimulus and the background (e.g., AX vs. X), even if the background changed between preexposure and test (AY vs. Y) (Experiment 2). In Experiment 3, the intermixed/blocked effect was observed when, in preexposure, stimulus presentations were alternated with the background alone (e.g., AX/X). This suggests that the perceptual learning effect is not the consequence of inhibitory associations between unique features but to increased salience of those features. Experiment 4 confirmed this finding and also ruled out an account of the effect in terms of trial spacing.     

Behavioral and ERP measures of holistic face processing in a composite task

Holistic processing of faces is characterized by encoding of the face as a single stimulus. This study employed a composite face task to examine whether holistic processing varies when attention is restricted to the top as compared to the bottom half of the face, and whether evidence of holistic processing would be observed in event-related potentials. Analyses of behavioral data showed that spatial misalignment of the face halves disrupted holistic processing and enhanced detection of repeated attended halves. Effects of misalignment on the N170, VPP and N250 ERP components resembled effects of face inversion. Attention to the top half of the face was associated with faster P1, N170, VPP, and P2 latencies than attending to the bottom, suggesting automatic processing of the eye region. Further, N170 latency effects suggested that structural encoding of the face is facilitated during holistic processing. N250 latency effects reflected task difficulty. Finally, an overall right hemispheric asymmetry was most pronounced when holistic face processing was greatest. Results are discussed in light of recent proposals that holistic face processing is a subtype of configural face processing.     

The intermixed-blocked effect in human perceptual learning is not the consequence of trial spacing

A robust finding in humans and animals is that intermixed exposure to 2 similar stimuli (AX/BX) results in better discriminability of those stimuli on test than does exposure to 2 equally similar stimuli in 2 separate blocks (CX_DX)--the intermixed-blocked effect. This intermixed-blocked effect may be an example of the superiority of spaced over massed practice; in the intermixed, but not the blocked exposure regime, each presentation of a given stimulus (e.g., AX) is separated from the next by the presentation of its partner (BX). Two experiments with human participants replicated the intermixed-blocked effect and showed that the effect was not due to the spacing of exposure trials. A mechanism for the intermixed-blocked effect is proposed, which combines theories from associative learning and memory.     

A Cognitive (Attributions)-Emotion Model of Observer Reactions to Free-Riding Poor Performers

Whereas most free-riding research has focused on limiting free-riding and on understanding free-riding motives, we were concerned with capturing the psychological processes used by observers to interpret the poor performance behavior of a team member. Using a sample of 268 observers of a simulated team interaction, we found that peer reactions to a poor performance could be explained through attribution theory (AT). Poor performers perceived as possessing high general cognitive ability (g) and low conscientiousness traits were more likely to be rated high on free-riding when compared to those perceived as possessing low g/low conscientiousness traits. In addition, AT helped explain observer anger and intent to punish free-riders.

Predictors of intimacy in couples' discussions of relationship injuries: an observational study.

The interpersonal process model of intimacy (H. T. Reis & P. Shaver, 1988) proposes that self-disclosure and empathic responding form the basis of intimate interactions. This study examined this model in 102 community couples who completed intimacy measures following videotaped discussions about relationship injuries occurring both within and outside the relationship. Observational assessments of self-disclosure and empathic responding, as well as their respective components, were related to self-reported ratings of post-interaction intimacy. Men's own disclosure and empathic responding predicted their feelings of intimacy, whereas women's intimacy was predicted by their partner's disclosure and empathic responding. Self-disclosure and empathic responding appear to be important behavioral determinants of intimate feelings, but the manner in which they influence intimacy differs according to gender.