Group Cognitive-Behavioral Therapy for Insomnia in a VA Mental Health Clinic

Effective cognitive-behavioral therapies for insomnia have been developed over the past 2 decades, but they have not been systematically evaluated in some clinical settings. While insomnia is common among veterans with mental health problems, the availability of effective treatments is limited. We report on the group application of a cognitive-behavioral therapy for chronic insomnia in a veteran population with significant comorbidity for both psychiatric problems and chronic medical conditions. Outcome measures were obtained for both sleep (via sleep diaries) and daytime functioning. Substantial posttreatment improvements were evident for measures of sleep consolidation, total sleep time, depression, anxiety, and fatigue. The unique suitability of the group therapy approach with this population is discussed. Controlled evaluations of the group cognitive-behavioral treatment for comorbid insomnia in this and other ambulatory settings are warranted.     

Orienting, emotion, and memory: phasic and tonic variation in heart rate predicts memory for emotional pictures in men

Arousal-related processes associated with heightened heart rate (HR) predict memory enhancement, especially for emotionally arousing stimuli. In addition, phasic HR deceleration reflects "orienting" and sensory receptivity during perception of stimuli. We hypothesized that both tonic elevations in HR as well as phasic HR deceleration during viewing of pictures would be associated with deeper encoding and better subsequent memory for stimuli. Emotional pictures are more memorable and cause greater HR deceleration than neutral pictures. Thus, we predicted that the relations between cardiac activity and memory enhancement would be most pronounced for emotionally-laden compared to neutral pictures. We measured HR in 53 males during viewing of unpleasant, neutral, and pleasant pictures, and tested memory for the pictures two days later. Phasic HR deceleration during viewing of individual pictures was greater for subsequently remembered than forgotten pictures across all three emotion categories. Elevated mean HR across the entire encoding epoch also predicted better memory performance, but only for emotionally arousing pictures. Elevated mean HR and phasic HR deceleration were associated, such that individuals with greater tonic HR also showed greater HR decelerations during picture viewing, but only for emotionally arousing pictures. Results suggest that tonic elevations in HR are associated both with greater orienting and heightened memory for emotionally arousing stimuli.     

Stigma and beliefs of efficacy towards traditional Chinese medicine and Western psychiatric treatment among Chinese-Americans

In this study we examined community attitudes of efficacy and shame to investigate the factors that may underlie mental health service underutilization among Chinese Americans. We administered an experimental vignette to assess beliefs of efficacy and shame toward using traditional Chinese medicine (TCM) as opposed to Western health services in a sample of 90 Chinese Americans obtained through a national telephone survey. Contrary to predictions, beliefs of efficacy for treating mental disorders were found to be greater for Western psychiatric services when compared with TCM. As predicted however, Chinese Americans perceived greater community attitudes of shame when accessing Western psychiatric services as opposed to TCM to treat a mental disorder. Furthermore, these differences in community attitudes of shame only occurred among respondents who received a psychiatric condition vignette, but not with respondents who were administered a vignette of a physical disorder. These findings suggest that perceived shame may play an important role in help seeking and that integration of TCM with Western psychiatric care may have implications for reducing shame for Chinese Americans.     

Keeping one's distance: the influence of spatial distance cues on affect and evaluation

Current conceptualizations of psychological distance (e.g., construal-level theory) refer to the degree of overlap between the self and some other person, place, or point in time. We propose a complementary view in which perceptual and motor representations of physical distance influence people's thoughts and feelings without reference to the self, extending research and theory on the effects of distance into domains where construal-level theory is silent. Across four experiments, participants were primed with either spatial closeness or spatial distance by plotting an assigned set of points on a Cartesian coordinate plane. Compared with the closeness prime, the distance prime produced greater enjoyment of media depicting embarrassment (Study 1), less emotional distress from violent media (Study 2), lower estimates of the number of calories in unhealthy food (Study 3), and weaker reports of emotional attachments to family members and hometowns (Study 4). These results support a broader conceptualization of distance-mediated effects on judgment and affect.     

Microstructural integrity of the corpus callosum linked with neuropsychological performance in adolescents

Background: Diffusion tensor imaging (DTI) has revealed microstructural aspects of adolescent brain development, the cognitive correlates of which remain relatively uncharacterized. Methods: DTI was used to assess white matter microstructure in 18 typically developing adolescents (ages 16–18). Fractional anisotropy (FA) and mean diffusion (MD) were evaluated within the splenium and body of the corpus callosum in relation to cognitive performance. Results: Visuospatial construction abilities were associated with white matter integrity in both the splenium and body of the corpus callosum, while only splenium integrity was associated with language and psychomotor function. Conclusion: Results suggest that, for typically developing adolescents, white matter coherence positively relates to visuospatial, psychomotor, and language skills. These findings may have implications for the cognitive functioning of clinical populations in which typical white matter development is altered.     

Mapping an HIV/STD prevention curriculum for Zambian in-school settings

HIV/AIDS poses grave risk to human development in sub-Saharan Africa. Evidence-based interventions that are rooted in local culture could help efforts to prevent threats to human development from HIV/AIDS. We used concept mapping (Concept System, 2006 ) to construct the components and content of a locally developed HIV/AIDS curriculum for use by secondary schools in Lusaka, Zambia. Participants were school counsellors (n = 14), youth health program officers (n = 7), and regular education teachers (n = 3) from the education, health, and youth development agencies in Lusaka, Zambia (males = 11; females = 13; mean age 38; SD = 15 years). Concept mapping yielded six statement clusters defining preliminary components of a locally grounded in-school HIV/AIDS prevention curriculum and the content items that define these components: (1) life skills education (18 items), (2) sexuality and reproductive health (10 items), (3) treatment, care and support (13 items), (4) counselling (12 items), (5) basic facts about HIV/AIDS (11 items), and (6) dissemination of information about HIV/AIDS (11 items). Zambian locally constructed constructs for an HIV/STD prevention curriculum overlap those promoted by public health programs in the country and internationally.     

Children with Comorbid Speech Sound Disorder and Specific Language Impairment are at Increased Risk for Attention-Deficit/Hyperactivity Disorder

This study focuses on the comorbidity between attention-deficit/hyperactivity disorder (ADHD) symptoms and speech sound disorder (SSD). SSD is a developmental disorder characterized by speech production errors that impact intelligibility. Previous research addressing this comorbidity has typically used heterogeneous groups of speech-language disordered children. This study employed more precise speech-language diagnostic criteria and examined ADHD symptomatology in 108 SSD children between the ages of 4 and 7 years old with specific language impairment (SLI) (n = 23, 14 males, 9 females) and without SLI (n = 85, 49 males, 36 females). We also examined whether a subcategory of SSD, persistent (n = 39, 25 males, 14 females) versus normalized SSD (n = 67, 38 males, 29 females), was associated with ADHD and/or interacted with SLI to predict ADHD symptomatology. Results indicated that participants in the SSD + SLI group had higher rates of inattentive ADHD symptoms than those in the SSD-only and control groups. In addition, an unexpected interaction emerged such that children with SLI and normalized-SSD had significantly higher ADHD inattentive ratings than the other subgroups. A proposed explanation for this interaction is discussed.     

Categorization in the wild

In studying categorization, cognitive science has focused primarily on cultural categorization, ignoring individual and institutional categorization. Because recent technological developments have made individual and institutional classification systems much more available and powerful, our understanding of the cognitive and social mechanisms that produce these systems is increasingly important. Furthermore, key aspects of categorization that have received little previous attention emerge from considering diverse types of categorization together, such as the social factors that create stability in classification systems, and the interoperability that shared conceptual systems establish between agents. Finally, the profound impact of recent technological developments on classification systems indicates that basic categorization mechanisms are highly adaptive, producing new classification systems as the situations in which they operate change.     

A theory about the nature of Evil

This article raises the nature of Evil as a dimension of spiritual reality and indicates some experience-based and some theologically based perspectives on the nature of Evil. The author offers a new perspective on the nature of Evil based on an extension of earlier work on a six-factor model of spirituality.     

Walking a mile in their patients' shoes: empathy and othering in medical students' education

One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy.