Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl

The alpha-2 adrenergic receptor antagonist, yohimbine, can facilitate fear extinction in animals and humans. One potential mechanism is increased noradrenergic activity and associated arousal in the presence of conditioned stimuli. Accordingly, yohimbine might augment prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD), where heightened exposure-oriented arousal is a theorized driver and empirical predictor of treatment success. A double-blind placebo-controlled randomized trial (NCT 01031979) piloted yohimbine augmentation in 26 males with combat-related PTSD. Participants were given one-time dose of yohimbine or placebo prior to the first imaginal exposure. Subsequently, both arms completed standard PE. The primary outcome was trauma-cued heart-rate reactivity a week after the drug/exposure visit, a highly specified, objective measure sensitive to incremental change. Secondary outcomes included arousal during the drug/exposure visit and slope of distress, PTSD, and depression over the course of PE. Consistent with hypothesis, yohimbine led to higher objective and subjective arousal during the drug/exposure visit and to lower trauma-cued heart-rate reactivity one-week later. One dose of yohimbine also led to greater between-session habituation and more rapid improvement on depression, but not PTSD, over the course of care. Results of this controlled pilot indicate support for continued investigation of yohimbine-augmented exposure therapy for PTSD.     

Parkinson’s Disease: Patients’ Knowledge,Attitudes, and Interest in Genetic Counseling

The objective of this study was to assess the genetics knowledge of patients with Parkinson’s disease (PD), and to explore their attitudes on genetic testing and interest in genetic counseling. We surveyed 158 patients from the University of Maryland Parkinson’s Disease and Movement Disorders Center. Patients averaged a score of 63% on general genetics knowledge and 73% on PD genetics knowledge. Participants had an overall positive attitude toward genetic testing: 80% believed that the use of genetic tests among people should be promoted, and 83% would undertake genetic test for PD if it was available. Patients reported a high interest to discuss the benefits, risks, and impacts of genetic testing for PD (mean sum score?=?26, range?=?9–35), and 43% patients expressed interest in meeting with a genetic counselor. Multivariate regression analysis showed that patients who had more positive attitudes toward genetic testing for PD were more interested in meeting with a genetic counselor (β?=?0.6, p?<?0.001). This study is the first to demonstrate an interest in genetic counseling among patients with PD. Our findings demonstrate a new niche for genetic counselors to support patients in clarifying gaps or misconceptions in knowledge about PD genetics as well as the possible risks, benefits, and limitations of genetic testing.     

Acceptability,Feasibility, and Effectiveness of Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in New York

Cognitive-behavioral therapy (CBT), consisting of exposure and response prevention (EX/RP), is both efficacious and preferred by patients with obsessive–compulsive disorder (OCD), yet few receive this treatment in practice. This study describes the implementation of an Internet-based CBT program (ICBT) developed in Sweden in individuals seeking OCD treatment in New York. After translating and adapting the Swedish ICBT for OCD, we conducted an open trial with 40 adults with OCD. Using the RE-AIM implementation science framework, we assessed the acceptability, feasibility, and effectiveness of ICBT. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Of 40 enrolled, 28 participants completed the 10-week ICBT. In the intent-to-treat sample (N = 40), Y-BOCS scores decreased significantly over time (F = 28.12, df = 2, 49, p < . 001). Depressive severity (F = 5.87, df = 2, 48, p < . 001), and quality of life (F = 12.34, df = 2, 48, p < . 001) also improved. Sensitivity analyses among treatment completers (N = 28) confirmed the intent-to-treat results, with a large effect size for Y-BOCS change (Cohen’s d = 1.38). ICBT took less time to implement than face-to face EX/RP and participants were very to mostly satisfied with ICBT. On a par with results in Sweden, the adapted ICBT program reduced OCD and depressive symptoms and improved quality of life among individuals with moderate to severe OCD. Given its acceptability and feasibility, ICBT deserves further study as a way to increase access to CBT for OCD in the United States.     

A progressive model for teaching children with autism to follow gaze shift

Gunby, Rapp, Bottoni, Marchese and Wu (2017) taught three children with autism spectrum disorder to follow an instructor's gaze shift to select a specific item; however, Gunby et al. used different types of prompts with each participant. To address this limitation, we used a progressive training model for increasing gaze shift for three children with autism spectrum disorder. Results show that each participant learned to follow an adult's shift in gaze to make a correct selection. In addition, two participants displayed the skill in response to a parent's gaze shift and with only social consequences; however, the third participant required verbal instruction and tangible reinforcement to demonstrate the skill outside of training sessions.     

Expert and Target Scoring: Their relation,corresponding test instructions,and their effects on the construct validity of the video‐based social understanding test (VSU)

This study investigated the relation between expert and target scoring of a video‐based social understanding test (VSU) under two different types of instructions (internal and observer). The effects of the scoring methods and instructions on the VSU's construct validity were also examined. A total of 529 pilot applicants completed the VSU (some with internal and some with observer instructions), cognitive ability and knowledge tests, and a personality questionnaire. A subsample (n = 132) completed the VSU again with the other instructions and participated in an assessment center (AC). The two scores were moderately correlated; correlations decreased when the instructions were considered. Neither expert nor target scores showed convergent validity with AC variables; none of the scoring‐instruction combinations showed significant associations with the remaining measures.     

Perceived relationship with God moderates the relationship between social comparison and body appreciation

Social comparison has been shown to contribute to the negative attitudes that most Western women have towards their bodies. However, minimal research has addressed the relationship between social comparison and body appreciation, which entails holding favourable opinions towards the body, accepting the body along with its deviations from societal beauty ideals, respecting the body by engaging in healthy behaviours, and protecting the body by rejecting unrealistic media appearance ideals. This study tested whether feeling loved and accepted by God would weaken the inverse relationship between social comparison and body appreciation among a sample of 186 female undergraduates. Results showed that frequent body-related comparisons were related to lower body appreciation, but this relationship was conditional upon the quality of women's perceived relationship with God. Results suggest that future research should explore interventions designed to create improved secure attachment relationships between clients and God.     

Pluralistic folk psychology and varieties of self-knowledge: an exploration

Turning the techniques we use to understand other people onto ourselves can provide an insight into the types of self-knowledge that may be possible for us. Adopting Pluralistic Folk Psychology, according to which we understand others not primarily by thinking about invisible beliefs and desires that cause behavior, but instead by modeling others as people - with rich characters, relationships, past histories, cultural embeddedness, personality traits, and so forth. A preliminary investigation shows that we understand ourselves at least in terms of our phenomenal states, informational states, perceptual states, traits, desires, and beliefs. I then appeal to empirical research to examine the accuracy of our sense of self-understanding in these ways, and argue that these are often non-veridical. Moreover, in our folk practices, we do not take our statements of self-understanding as infallible, but we allow others to help us see ourselves. While there is room for some improvement in our acurarcy, I conclude that our sense of self is largely a joint construct of self and others, and that looping effects play a significant role in what one’s self turns out to be. The self is a fluid thing that we are constantly creating through our actions and self-constituting thoughts, but it is a creation we do not make alone. Others help to create us, as we help to create them.     

Strategies in probabilistic categorization: results from a new way of analyzing performance

The "Weather Prediction" task is a widely used task for investigating probabilistic category learning, in which various cues are probabilistically (but not perfectly) predictive of class membership. This means that a given combination of cues sometimes belongs to one class and sometimes to another. Prior studies showed that subjects can improve their performance with training, and that there is considerable individual variation in the strategies subjects use to approach this task. Here, we discuss a recently introduced analysis of probabilistic categorization, which attempts to identify the strategy followed by a participant. Monte Carlo simulations show that the analysis can, indeed, reliably identify such a strategy if it is used, and can identify switches from one strategy to another. Analysis of data from normal young adults shows that the fitted strategy can predict subsequent responses. Moreover, learning is shown to be highly nonlinear in probabilistic categorization. Analysis of performance of patients with dense memory impairments due to hippocampal damage shows that although these patients can change strategies, they are as likely to fall back to an inferior strategy as to move to more optimal ones.     

Perceived health: a test of incremental validity in relation to smoking outcome expectancies, motivation to smoke and desire to quit smoking

This study examined the role of perceived health in predicting theoretically-relevant aspects of smoking behavior among 161 young adult regular smokers (67 females; mean age = 21.9 years (SD = 7.2), cigarettes per day (M) = 12.2 (SD = 5.7)) recruited from the general community. Consistent with prediction, results indicated that relative to anxiety sensitivity, gender, number of cigarettes smoked per day and nicotine dependence, perceived physical health uniquely and significantly predicted expectancies for negative affect reduction and expectancies that smoking would lead to negative personal consequences. Additionally, perceived health incrementally predicted motivation to smoke to reduce negative affect. In contrast to expectation, perceived health was unrelated to motivation to quit smoking. Results are discussed in relation to the role of perceived health as a cognitive vulnerability factor for specific types of smoking patterns.