Health Anxiety: Latent Structure and Associations with Anxiety-related Psychological Processes in a Student Sample

Although currently classified as a somatoform disorder, cognitive-behavioral models conceptualize hypochondriasis (HC) as a severe form of health anxiety. The Short Health Anxiety Inventory (SHAI) is a measure derived from this conceptualization that measures health anxiety symptoms across the range of severity. Previous studies have reported inconsistent findings regarding this measure’s factor structure, but these studies employed factor analytic tools that did not account for the categorical nature of SHAI items. The present psychometric study was designed to address these inconsistencies using categorical factor analysis. Using data from a large student sample we found that the SHAI had two factors: Illness Likelihood and Illness Severity. We also examined the relationship between these domains and cognitive variables associated with other anxiety disorders. Results suggested that the psychological processes present in obsessive-compulsive disorder and panic disorder are also associated with health anxiety. Implications for the conceptualization and classification of severe health anxiety are discussed.     

Educational Hegemony,Traumatic Stress,and African American and Latino American Students

The authors use traumatic stress theory to develop an ecosystemic understanding of hegemony and systemic barriers to educational success for culturally diverse students. Scholarship on trauma and systemic oppression are applied to students' academic experiences, and recommendations for improving educational outcomes include assessing for and ameliorating trauma in educational settings. Los autores emplean teorías del estrés traumático para desarrollar un entendimiento ecosistemático de la hegemonía y las barreras sistémicas para el éxito académico de estudiantes culturalmente diversos. Se aplica el conjunto de las investigaciones sobre trauma y opresión sistémica a las experiencias académicas de los estudiantes, y las recomendaciones para mejorar el rendimiento educativo incluyen la evaluación y alivio de los niveles de trauma en entornos educativos.     

Commitment Predictors: Long‐Distance Versus Geographically Close Relationships

In this web‐based study, the authors examined long‐distance relationships (LDRs) and geographically close relationships (GCRs). Two hierarchical multiple regressions (N = 138) indicated that attachment predicted LDR and GCR commitment in Step 1. Final equations indicated that high satisfaction and investments predicted LDR commitment, whereas low attachment avoidance, low cooperative caregiving, high satisfaction, and low alternatives predicted GCR commitment. The pattern of predictors differed for LDRs versus GCRs.     

Maladaptive Cognitions and Chronic Pain: Epidemiology,Neurobiology, and Treatment

Maladaptive cognitions are widespread and play a significant role in the development of chronic pain. (1) Catastrophizing seems to increase the risk of chronicity. In the laboratory it amplifies temporal summation of pain with repeated stimulation and delays the disengagement of attention from pain. In neuroimaging it is associated with increased activation in regions of the cortex involved in attention, the aversiveness of pain, and possibly pain intensity. (2) Fearful anticipation of pain seems to pre-activate brain regions involved in both the sensory and emotional intensity of pain and primes a stronger initial pain response. It may lead to abnormal patterns of muscle recruitment that, speculatively, may predispose to injury. (3) Belief that normal activity should be avoided seems to promote unnecessary long-term disability in nonspecific low back pain. Extreme guarding may intensify pain through loss of inhibition from motor cortex. (4) Educational programs targeting maladaptive beliefs have shown benefit in the primary prevention of chronic back pain in both pain-free and acute pain populations. In established chronic pain, cognitive-behavioral therapy has shown efficacy in improving pain intensity, coping and pain behaviors when compared with usual treatment. (5) Possible future research directions and clinical implications are discussed.     

Dimensional, categorical, or dimensional-categories: testing the latent structure of anxiety sensitivity among adults using factor-mixture modeling

The present study tested multiple, competing latent structural models of anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007). Data were collected from 3 sites in North America (N = 634). Participants were predominantly university students (M = 21.3 years, SD = 5.4). ASI-3 data were evaluated using an integration of mixture modeling and confirmatory factor analysis—factor mixture modeling (FMM; Muthén, 2008). Results supported a 2-class 3-factor partially invariant model of AS. Specifically, the FMM analyses indicated that AS is a taxonic (two-class) variable, and that each categorical class has a unique multidimensional factor structure. Consistent with the specific point-prediction regarding the hypothesized parameters of the putative latent class variable, FMM indicated that the putatively “high-risk” subgroup of cases or latent form of AS composed approximately 12% of the studied sample whereas the putatively “normative” subgroup of cases or latent form of AS composed 88% of the sample. In addition, the AS Physical and Psychological Concerns subscales, but not the Social Concerns subscale, most strongly discriminated between the two latent classes. Finally, comparison of continuous levels of AS Physical and Psychological Concerns between FMM-derived AS latent classes and independent clinical samples of patients with anxiety disorders provided empirical support for the theorized taxonic-dimensional model of AS and anxiety psychopathology vulnerability. Findings are discussed in regard to the implications of this and related research into the nature of AS and anxiety psychopathology vulnerability.     

A motion aftereffect from visual imagery of motion

Mental imagery is thought to share properties with perception. To what extent does the process of imagining a scene share neural circuits and computational mechanisms with actually perceiving the same scene? Here, we investigated whether mental imagery of motion in a particular direction recruits neural circuits tuned to the same direction of perceptual motion. To address this question we made use of a visual illusion, the motion aftereffect. We found that following prolonged imagery of motion in one direction, people are more likely to perceive real motion test probes as moving in the direction opposite to the direction of motion imagery. The transfer of adaptation from imagined to perceived motion provides evidence that motion imagery and motion perception recruit shared direction-selective neural circuitry. Even in the absence of any visual stimuli, people can selectively recruit specific low-level sensory neurons through mental imagery.     

Applying signal-detection theory to the study of observer accuracy and bias in behavioral assessment

We evaluated the feasibility and utility of a laboratory model for examining observer accuracy within the framework of signal-detection theory (SDT). Sixty-one individuals collected data on aggression while viewing videotaped segments of simulated teacher-child interactions. The purpose of Experiment 1 was to determine if brief feedback and contingencies for scoring accurately would bias responding reliably. Experiment 2 focused on one variable (specificity of the operational definition) that we hypothesized might decrease the likelihood of bias. The effects of social consequences and information about expected behavior change were examined in Experiment 3. Results indicated that feedback and contingencies reliably biased responding and that the clarity of the definition only moderately affected this outcome.     

The Functional Analytic Psychotherapy Rating Scale: a Replication and Extension

Few theories of psychotherapy give direction to the therapist on a moment-to-moment level or make predictions about how specific therapist techniques change client behavior in session. Functional analytic psychotherapy (FAP, Kohlenberg and Tsai in Functional analytic psychotherapy: a guide for creating intense and curative therapeutic relationships. Plenum, New York 1991) provides this direction and prediction. Specifically, FAP claims that client problem behaviors will be displayed in the therapeutic relationship and that the therapist can improve client in-session behavior through differential, contingent responding. Further, it is assumed that these improvements in session can be generalized to out of session relationships. The FAP rating scale (FAPRS) was developed for the purpose of coding in-session client and therapist behaviors in an effort to test FAP’s purported mechanism of change. The current study seeks to replicate and extend initial FAPRS findings (Callaghan et al. in J Contemp Psychother 33:321–339, 2003) regarding mechanism of change and to address transportability. FAPRS coding data from a single successful case of an individual diagnosed with Borderline Personality Disorder and treated with FAP is presented. Results indicate that the FAPRS system is transportable and are generally supportive of the claim that therapist contingent responding leads to client improvement.     

On Sinnott-Armstrong’s Case Against Moral Intuitionism

Walter Sinnott-Armstrong has argued against moral intuitionism, according to which some of our moral beliefs are justified without needing to be inferred from any other beliefs. He claims that any prima facie justification some non-inferred moral beliefs might have enjoyed is removed because many of our moral beliefs are formed in circumstances where either (1) we are partial, (2) others disagree with us and there is no reason to prefer our moral judgement to theirs, (3) we are emotional in a way that clouds our judgement, (4) the circumstances are conducive to illusion, or (5) the source of our moral beliefs is unreliable or disreputable. I take issue with the elements of Sinnott-Armstrong’s argument that centre on (1) to (3) and (5), concluding that his case against moral intuitionism is unpersuasive.     

Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry

The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement’s aim of providing appropriate treatment and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs.