Why do people with an anxiety disorder utilize more nonmental health care than those without?

OBJECTIVE: It is unclear why nonmental healthcare utilization is greater among those with psychological problems. The authors examined healthcare utilization in HMO patients to determine whether greater utilization in anxiety disorder (AD) patients was explained by anxiety symptoms (increasing sensitivity to physical symptoms) or comorbid illness (causing greater need for services). DESIGN: Patients were randomly selected from the database of a multi-specialty practice and 1,041 completed a survey assessing psychological symptoms, health behaviors, and demographics. Anxiety symptoms were assessed by questionnaire and the presence of an AD was determined from the medical chart. Healthcare encounters and medication use were abstracted from medical charts and HMO claims data. MAIN OUTCOME MEASURES: Healthcare utilization. RESULTS: Both AD and anxiety symptoms predicted utilization, but symptoms were not associated with utilization in a model that also included AD. Comorbid illness was significantly associated with utilization independent of AD and somewhat reduced the strength of the AD-utilization association. The results were replicated in comparison of those with any psychiatric disorder to those without. CONCLUSION: Among those with AD, greater utilization is not explained by anxiety symptoms but is partly explained by greater comorbid illness. Further study is needed to understand excess healthcare utilization among AD patients.     

So that's why I don't remember: normalizing forgetting of childhood events influences false autobiographical beliefs but not memories

We investigated changes in autobiographical belief and memory ratings for childhood events, after informing individuals that forgetting childhood events is common. Participants received false prevalence information (indicating that a particular childhood event occurred frequently in the population) plus a rationale normalizing the forgetting of childhood events; false prevalence information alone; or no manipulation, for one (Study 1) or two (Study 2) unlikely childhood events. Results demonstrated that combining prevalence information and the "forgetting rationale" substantially influenced autobiographical belief ratings, whereas prevalence information alone had no impact (Study 1) or a significantly lesser impact (Study 2) on belief ratings. Prevalence information consistently impacted plausibility ratings. No changes in memory ratings were observed. These results provide further support for a nested relationship between judgements of plausibility, belief, and memory in evaluating the occurrence of autobiographical events. Furthermore, the results suggest that some purported false memory phenomena may instead reflect the development of autobiographical false beliefs in the absence of memory.     

Does providing props during preparation help children to remember a novel event?

We investigated the conditions under which preparatory information presented 1 day before a novel event influenced 6-year-olds' recall 1 week later. Children were assigned to one of six experimental conditions. Three conditions involved preparatory information that described the event accurately but differed according to the presence and type of props (verbal, real props, and toy props). In two conditions, which also differed according to whether verbal information was supplemented with real props, half of the preparatory information described the event accurately, whereas the other half was thematically similar to, but inconsistent with, the event (misleading verbal and misleading props). Compared with the attentional control condition, all forms of preparation that described the event accurately increased correct recall. Preparation that included props improved photograph recognition. When half of the accurate information was replaced by misleading information, the positive benefit on recall was reduced, and when misleading props accompanied the misleading information, errors increased. The potential underlying mechanisms and implications for pediatric settings are discussed.     

Children's mappings of large number words to numerosities

Previous studies have suggested that children's learning of the relation between number words and approximate numerosities depends on their verbal counting ability, and that children exhibit no knowledge of mappings between number words and approximate numerical magnitudes for number words outside their productive verbal counting range. In the present study we used a numerical estimation task to explore children's knowledge of these mappings. We classified children as Level 1 counters (those unable to produce a verbal count list up to 35), Level 2 counters (those who were able to count to 35 but not 60) and Level 3 counters (those who counted to 60 or above) and asked children to estimate the number of items on a card. Although the accuracy of children's estimates depended on counting ability, children at all counting skill levels produced estimates that increased linearly in proportion to the target number, for numerosities both within and beyond their counting range. This result was obtained at the group level (Experiment 1) and at the level of individual children (Experiment 2). These findings provide evidence that even the least skilled counters do exhibit some knowledge of the form of the mapping between large number words and approximate numerosities.     

The listener's temperament and perceived tempo and loudness of music

The relationship between the listener's temperament and perceived magnitude of tempo and loudness of music was studied using the techniques of magnitude production, magnitude estimation scaling and cross‐modal matching. Four piano pieces were presented at several levels of tempo and loudness. In Study 1, participants adjusted tempo and loudness of music to their subjective level of comfort. In Study 2, participants estimated these parameters on a numerical scale and matched the length of a line segment to the estimates of these musical features. The results showed significant correlations of selected aspects of perceived tempo with perseveration and endurance as well as of selected aspects of perceived loudness with endurance and emotional reactivity. Perceived tempo and loudness, as measured by magnitude production and cross‐modal matching tasks, do not seem to systematically correlate with the six formal characteristics of behaviour distinguished in the most recent version of the Regulative Theory of Temperament (RTT). Additionally, there is some evidence that they are selectively associated with reactivity and activity, the dimensions of a previous version of the RTT. The study extends the methodology of research on music preferences and the stimulatory value of music. Copyright © 2009 John Wiley & Sons, Ltd.     

Evidence That Self-Relevant Motives and Metaphoric Framing Interact to Influence Political and Social Attitudes

ABSTRACT— We propose that metaphor is a mechanism by which motivational states in one conceptual domain can influence attitudes in a superficially unrelated domain. Two studies tested whether activating motives related to the self-concept influences attitudes toward social topics when the topics' metaphoric association to the motives is made salient through linguistic framing. In Study 1, heightened motivation to protect one's own body from contamination led to harsher attitudes toward immigrants entering the United States when the country was framed in body-metaphoric, rather than literal, terms. In Study 2, a self-esteem threat led to more positive attitudes toward binge drinking of alcohol when drinking was metaphorically framed as physical self-destruction, compared with when it was framed literally or metaphorically as competitive other-destruction.     

Treatment for anxiety disorders: Efficacy to effectiveness to implementation

Anxiety disorders are common, costly and debilitating, and yet often unrecognized or inadequately treated in real world, primary care settings. Our group has been researching ways of delivering evidence-based treatment for anxiety in primary care settings, with special interest to preserving the fidelity of the treatment while at the same time promoting its sustainability once the research is over. In this paper, we describe the programs we have developed and our directions for future research. Our first study evaluated the efficacy of CBT and expert pharmacotherapy recommendations for panic disorder in primary care, using a collaborative care model of service delivery (CCAP). Symptom, disability and mental health functioning measures were superior for the intervention group compared to treatment as usual both in the short term and the long term, although also more costly. In our ongoing CALM study, we have extended our population to include panic disorder, social anxiety disorder, generalized anxiety disorder and posttraumatic disorder, while at the same time utilizing clinicians with limited mental health care experience. In addition to pharmacotherapy management, we developed a computer-assisted CBT that guides both novice clinician and patient, thereby contributing to sustainability once the research is over. We have also incorporated a measurement based approach to treatment planning, using a web-based tracking system of patient status. To date, the computer-assisted CBT program has been shown to be acceptable to clinicians and patients. Clinicians rated the program highly, and patients engaged in the program. Future directions for our research include dissemination and implementation of the CALM program, testing potential alternations to the CALM program, and distance delivery of CALM.     

USE OF LATENCY TO PROBLEM BEHAVIOR TO EVALUATE DEMANDS FOR INCLUSION IN FUNCTIONAL ANALYSES

Few direct‐assessment procedures are designed to identify potential negative reinforcers (e.g., including demands in the escape condition of functional analyses). Two participants were systematically exposed to a series of demands nominated by caregivers as potential negative reinforcers. Sessions ended following the first instance of problem behavior, and a hierarchy of demand aversiveness was created based on the latency to the first problem behavior. Subsequent functional analyses confirmed the predictive value of the hierarchy, with shorter latency demands consistently producing more differentiated functional analysis outcomes.     

Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol

Acceptance and Commitment Therapy (ACT) is an innovative acceptance-based behavior therapy that has been applied broadly and successfully to treat a variety of clinical problems, including the anxiety disorders. Throughout treatment ACT balances acceptance and mindfulness processes with commitment and behavior change processes. As applied to anxiety disorders, ACT seeks to undermine excessive struggle with anxiety and experiential avoidance––attempts to down-regulate and control unwanted private events (thoughts, images, bodily sensations). The goal is to foster more flexible and mindful ways of relating to anxiety so individuals can pursue life goals important to them. This article describes in some detail a unified ACT protocol that can be adapted for use with persons presenting with any of the major anxiety disorders. To exemplify this approach, we present pre- and posttreatment data from three individuals with different anxiety disorders who underwent treatment over a 12-week period. The results showed positive pre- to posttreatment changes in ACT-relevant process measures (e.g., reductions in experiential avoidance, increases in acceptance and mindfulness skills), increases in quality of life, as well as significant reductions in traditional anxiety and distress measures. All three clients reported maintaining or improving on their posttreatment level of functioning.