Effectiveness of Cognitive-Behavioral Insomnia Treatment in a Community Sample of Older Individuals: More Questions than Conclusions

Effectiveness of two modified stimulus control insomnia interventions plus daily sleep self-monitoring for managing insomnia was investigated in a community sample of older adults. Significant post intervention improvement was observed in both interventions as well as in a self-monitoring only control condition. This unexpected finding led us to question the role of self-monitoring as a potential mediator of therapeutic change. Therefore, we compared long-term follow-up data from treated participants to data from similarly poor sleepers who only completed the questionnaire battery at Pre-test and long term follow-up, with no intervening treatment or self-monitoring. Both groups of poor sleepers reduced their reported amount of nocturnal wakefulness. However, only treated participants improved on their perceived frequency of insomnia episodes and insomnia-related distress. Our findings have implications both for the definition and the treatment of insomnia.     

A comparison of the correlational structures and elevation patterns of the MMPI-2 restructured clinical (RC) and clinical scales

The relationship between the MMPI-2 restructured clinical scales and the original clinical scales was evaluated using an outpatient clinical sample (N = 150). Similar patterns of correlations to those reported by Tellegen et al. in 2003, such as high correlations between the restructured scales and their original scale counterparts and lower intercorrelations among the restructured scales than among the original scales, were found in the outpatient sample. The former provided evidence of convergence between the two sets of scales, whereas the latter increases the potential for discriminant validity in the restructured scale profiles. Mean T-scores of the restructured scales were significantly lower than their original scale counterparts for every clinical scale except Scale 1 (hypochondriasis). Individual profiles exhibited fewer scale elevations using the restructured clinical scales (M = 2.15, Mdn = 2.0) than the original clinical scales (M = 3.29, Mdn = 3.0). The majority of client profiles (56%) had fewer scale elevations when plotted using the restructured scales versus the original clinical scales.     

Accuracy of self-evaluation in adults with ADHD: evidence from a driving study

Research on children with ADHD indicates an association with inaccuracy of self-appraisal. This study examines the accuracy of self-evaluations in clinic-referred adults diagnosed with ADHD. Self-assessments and performance measures of driving in naturalistic settings and on a virtual-reality driving simulator are used to assess accuracy of self-evaluations. The group diagnosed with ADHD (n= 44) has a higher rate of collisions, speeding tickets, and total driving citations in their driving history; report less use of safe driving behaviors in naturalistic settings; and use fewer safe driving behaviors in the simulator than the community comparison group (n= 44). Despite poorer performance, adults with ADHD provide similar driving self-assessments, thereby overestimating in naturalistic settings to a greater degree than the comparison group. These findings extend research in children with ADHD to an adult sample in an important domain of functioning and may relate to findings of executive deficits associated with ADHD.     

PAUSE for assessment: a multi-level long-term care assessment tool

The author of this article noes that as health care improves, paradoxically, long-term care residents become "older and sicker." In response, many facilities now offer a wide range of levels of residential care, from independent living to Hospice care--and all under the same roof. Chaplains in such facilities can play a key part in identifying changes in individual residents' needs over time. Toward this end, the author introduces PAUSE--a one-page questionnaire designed to be completed by the chaplain after a visit with a resident. The items reflect the chaplain's impressions of several key aspects of the resident's well-being from a single interaction. The questionnaire serves several purposes: it documents the fact of a visit; it allows comparison of impressions at different times and by different visitors; and it quickly highlights "red flag" areas of possible concern for interdisciplinary referral, pastoral follow-up, or possible change in level of care. It might also function as a teaching tool for student chaplains.     

Diathesis stress model for panic-related distress: a test in a Russian epidemiological sample

To investigate a cognitive diathesis-stress model, the present study evaluated the main and interactive effects of anxiety sensitivity (AS) and exposure to aversive conditions (past month) in predicting theoretically relevant panic vulnerability variables in an epidemiologically defined sample from Russia (N = 390). Consistent with expectation, findings suggested that the combination of high levels of exposure to aversive conditions and high AS physical concerns predicted panic attacks (past week) and agoraphobic avoidance above and beyond the variance accounted for by negative affect. These findings are discussed in relation to biopsychosocial theories of panic disorder, which emphasize the importance of both a cognitive diathesis and stress component in the pathogenesis of the disorder.     

Starting at the end: the importance of goals in spatial language

We explored the linguistic encoding of Paths in children between the ages of three and seven, in children with Williams syndrome, and in normal adults, focusing specifically on Source and Goal Paths. The results showed an asymmetry, with Goal Paths regularly and systematically encoded, but Source Paths often omitted. This pattern occurred among all groups and across a broad range of domains including Manner of Motion, Change of Possession, Change of State, and Attachment/Detachment events. It also occurred whether participants spontaneously described events or were asked to use a specific verb that biased them towards a Goal or Source Path (e.g. 'give' vs. 'get'). The results are discussed in terms of non-linguistic foundations of spatial language and the linguistic mapping biases that arise when we describe what we see.     

Effects of stimulus variation on the reinforcing capability of nonpreferred stimuli

We examined the effects of stimulus (reinforcer) variation in several different contexts. In Study 1, we identified high-quality (HQ) and low-quality (LQ) stimuli based on results of a paired-stimulus assessment and examined their effects when available under concurrent-reinforcement schedules for 8 participants. No participants showed preference for the LQ stimuli when compared singly or in a varied arrangement to the HQ stimulus. In Study 2, we identified nonpreferred (NP) stimuli based on results of a single-stimulus assessment and examined their effects when available under single-reinforcement schedules for 3 participants. Results of Study 2 were mixed. One participant's data indicated that the varied presentation of NP stimuli produced a modest improvement in performance over that observed when the stimuli were presented singly. By contrast, a second participant's data showed no facilitative effect for the varied delivery of NP stimuli and that the inclusion of an HQ stimulus in the varied arrangement obscured the reinforcing effects of the HQ stimulus. The 3rd participant's data showed no effect for the varied delivery of NP stimuli but an apparent facilitative effect when an HQ stimulus was included in the varied arrangement, which was attributable solely to the presence of the HQ stimulus.     

Amygdala responses to emotionally valenced stimuli in older and younger adults

Abstract— As they age, adults experience less negative emotion, come to pay less attention to negative than to positive emotional stimuli, and become less likely to remember negative than positive emotional materials. This profile of findings suggests that, with age, the amygdala may show decreased reactivity to negative information while maintaining or increasing its reactivity to positive information. We used event-related functional magnetic resonance imaging to assess whether amygdala activation in response to positive and negative emotional pictures changes with age. Both older and younger adults showed greater activation in the amygdala for emotional than for neutral pictures; however, for older adults, seeing positive pictures led to greater amygdala activation than seeing negative pictures, whereas this was not the case for younger adults.