The Current State of Intervention Research for Posttraumatic Stress Disorder Within the Primary Care Setting

Posttraumatic Stress Disorder (PTSD) is common among primary care patients and is associated with significant functional impairment, physical health concerns, and mental health comorbidities. Significant barriers to receiving adequate treatment often exist for primary care patients with PTSD. Mental health professionals operating as part of the primary care team have the potential to provide effective brief intervention services. While good PTSD screening and assessment measures are available for the primary care setting, there are currently no empirically supported primary care-based brief interventions for PTSD. This article reviews early research on the development and testing of primary care-based PTSD treatments and also reviews other brief PTSD interventions (i.e., telehealth and early intervention) that could be adapted to the primary care setting. Cognitive and behavioral therapies currently have the strongest evidence base for establishing an empirically supported brief intervention for PTSD in primary care. Recommendations are made for future research and clinical practice.     

Follow your heart: Emotion adaptively influences perception

The current review introduces a new program of research that suggests the perception of spatial layout is influenced by emotions. Though perceptual systems are often described as closed and insulated, this review presents research suggesting that a variety of induced emotions (e.g., fear, disgust, sadness) can produce changes in vision and audition. Thus, the perceptual system may be highly interconnected, allowing emotional information to influence perceptions that, in turn, influence cognition. The body of work presented here also suggests that emotion-based changes in perception help us solve particular adaptive problems because emotion does not change all perceptions of the world. Taking the adaptive significance of emotion into account allows us to make predictions about when and how emotion influences perception.     

Infants learn phonotactic regularities from brief auditory experience

Two experiments investigated whether novel phonotactic regularities, not present in English, could be acquired by 16.5-month-old infants from brief auditory experience. Subjects listened to consonant-vowel-consonant syllables in which particular consonants were artificially restricted to either initial or final position (e.g. /baep/ not /paeb/). In a later head-turn preference test, infants listened longer to new syllables that violated the experimental phonotactic constraints than to new syllables that honored them. Thus, infants rapidly learned phonotactic regularities from brief auditory experience and extended them to unstudied syllables, documenting the sensitivity of the infant's language processing system to abstractions over linguistic experience.     

Measuring transactive memory systems in the field: scale development and validation

This study describes the development and validity testing of a field measure of transactive memory systems. Transactive memory systems are especially important for teams designed to leverage members' expertise, but field research has lagged because there are no adequate measures of the construct. The author developed and tested a 15-item scale in a laboratory sample of 124 teams, a field sample of 64 Master of Business Administration consulting teams, and a field sample of 27 teams from technology companies. Results from the present study demonstrate that the scale is internally consistent, related to alternative measures and hypothesized causes and effects, and unrelated to theoretically distinct constructs, providing evidence of convergent, criterion-related, and discriminant validity. Suggestions for improving the scale, future validity testing, and possible boundary conditions are discussed.     

Choice in a variable environment: effects of unequal reinforcer distributions

Six pigeons were trained in a procedure in which sessions included seven unsignaled components, each offering two pecking keys, and each providing a potentially different reinforcer ratio between the two keys. Across conditions, various combinations of reinforcer ratios and reinforcer-magnitude ratios were used to create unequal reinforcer distributions between the two alternatives when averaged across a session. The results extended previous research using the same basic procedure that had included only reinforcer distributions symmetrical around 1:1. Data analyses suggested that the variables controlling choice operated at a number of levels: First, individual reinforcers had local effects on choice; second, sequences of successive reinforcers obtained at the same alternative (continuations) had cumulative effects; and, third, when these sequences themselves occurred with greater frequency, their effects further cumulated. A reinforcer obtained at the other alternative following a sequence of continuations (a discontinuation) had a large effect and apparently reset choice to levels approximating the sessional reinforcer ratio.     

Concurrent-schedule performance in transition: changeover delays and signaled reinforcer ratios

Six pigeons were trained in experimental sessions that arranged six or seven components with various concurrent-schedule reinforcer ratios associated with each. The order of the components was determined randomly without replacement. Components lasted until the pigeons had received 10 reinforcers, and were separated by 10-s blackout periods. The component reinforcer ratios arranged in most conditions were 27:1, 9:1, 3:1, 1:1, 1:3, 1:9 and 1:27; in others, there were only six components, three of 27:1 and three of 1:27. In some conditions, each reinforcement ratio was signaled by a different red-yellow flash frequency, with the frequency perfectly correlated with the reinforcer ratio. Additionally, a changeover delay was arranged in some conditions, and no changeover delay in others. When component reinforcer ratios were signaled, sensitivity to reinforcement values increased from around 0.40 before the first reinforcer in a component to around 0.80 before the 10th reinforcer. When reinforcer ratios were not signaled, sensitivities typically increased from zero to around 0.40. Sensitivity to reinforcement was around 0.20 lower in no-changeover-delay conditions than in changeover-delay conditions, but increased in the former after exposure to changeover delays. Local analyses showed that preference was extreme towards the reinforced alternative for the first 25 s after reinforcement in changeover-delay conditions regardless of whether components were signaled or not. In no-changeover-delay conditions, preference following reinforcers was either absent, or, following exposure to changeover delays, small. Reinforcers have both local and long-term effects on preference. The former, but not the latter, is strongly affected by the presence of a changeover delay. Stimulus control may be more closely associated with longer-term, more molar, reinforcer effects.     

Every reinforcer counts: reinforcer magnitude and local preference

Six pigeons were trained on concurrent variable-interval schedules. Sessions consisted of seven components, each lasting 10 reinforcers, with the conditions of reinforcement differing between components. The component sequence was randomly selected without replacement. In Experiment 1, the concurrent-schedule reinforcer ratios in components were all equal to 1.0, but across components reinforcer-magnitude ratios varied from 1:7 through 7:1. Three different overall reinforcer rates were arranged across conditions. In Experiment 2, the reinforcer-rate ratios varied across components from 27:1 to 1:27, and the reinforcer-magnitude ratios for each alternative were changed across conditions from 1:7 to 7:1. The results of Experiment 1 replicated the results for changing reinforcer-rate ratios across components reported by Davison and Baum (2000, 2002): Sensitivity to reinforcer-magnitude ratios increased with increasing numbers of reinforcers in components. Sensitivity to magnitude ratio, however, fell short of sensitivity to reinforcer-rate ratio. The degree of carryover from component to component depended on the reinforcer rate. Larger reinforcers produced larger and longer postreinforcer preference pulses than did smaller reinforcers. Similar results were found in Experiment 2, except that sensitivity to reinforcer magnitude was considerably higher and was greater for magnitudes that differed more from one another. Visit durations following reinforcers measured either as number of responses emitted or time spent responding before a changeover were longer following larger than following smaller reinforcers, and were longer following sequences of same reinforcers than following other sequences. The results add to the growing body of research that informs model building at local levels.     

Ecological Factors Impacting Provider Attitudes Towards Human Service Delivery Reform

Although reform efforts are substantially altering the structural operations and guiding ideological framework of the human service delivery system, little empirical work has been done to systematically examine these transformations. This study examines providers' attitudes regarding two reform elements that are being widely implemented: an increased emphasis on inter-agency collaboration and a shift from a medical model service delivery philosophy, that focuses on client deficits, to one that emphasizes consumer strengths. Through survey data collected from 186 providers from 32 human service agencies in one county, the relationship between providers' perceptions of contextual support for human service delivery reform and providers' attitudes towards these initiatives is explored. The findings from this study support the importance of attending to the ecology in which we initiate system reform efforts. For both reform elements, working within contexts that are perceived as providing ideological and functional support for change was associated with positive provider attitudes towards those changes. Staffs' perceptions of the external environment played the most critical role in shaping staff attitudes. Interestingly, unique aspects of providers' work environments were related to positive attitudes towards the two different reforms. The implications of these findings for the success of human service delivery reform are discussed.     

Leaving patches: effects of economy, deprivation, and session duration

Three pigeons pecked keys for food reinforcers in a laboratory analogue of foraging in patches. Half the patches contained food (were prey patches). In prey patches, pecks to one key occasionally produced a reinforcer, followed by a fixed travel time and then the start of a new patch. Pecks to another key were exit responses, and immediately produced travel time and then a new patch. Travel time was varied from 0.25 to 16 s at each of three session durations: 1, 4, and 23.5 hr. This part of the experiment arranged a closed economy, in that the only source of food was reinforcers obtained in prey patches. In another part, food deprivation was manipulated by varying postsession feeding so as to maintain the subjects' body weights at percentages ranging from 85% to 95% of their ad lib weights, in 1-hr sessions with a travel time of 12 s. This was an open economy. Patch residence time, defined as the time between the start of a patch and an exit response, increased with increasing travel time, and consistently exceeded times predicted by an optimal foraging model, supporting previously published results. However, residence times also increased with increasing session duration and, in longer sessions, consistently exceeded previously reported residence times in comparable open-economy conditions. Residence times were not systematically affected by deprivation levels. In sum, the results show that the long residence times obtained in long closed-economy sessions should probably be attributed to session duration rather than to economy or deprivation. This conclusion is hard to reconcile with previous interpretations of longer-than-optimal residence times but is consistent with, in economic terms, a predicted shift in consumption towards a preferred commodity when income is increased.