Internet-based cognitive behavioral therapy for anxiety in an outpatient specialized care setting: A qualitative study of the patients’ experience of the therapy

Knowledge about user experiences of internet-based cognitive behavioral therapy (iCBT) has mostly been drawn from non-clinical groups or with iCBT offered via self-referral. The present study therefore focused on patients who had undergone iCBT with minimal support while actively awaiting outpatient psychological treatment in the form of face-to-face CBT. To seek out barriers to adherence the study also included patients who had withdrawn from the iCBT treatment before completion. The study was performed in an outpatient clinic for anxiety disorders where twelve participants with a primary diagnosis of either social anxiety disorder or panic disorder were recruited from an ongoing randomized control trial for semi-structured interviews. Statements from the interviews showed that the iCBT treatment was unfavorably compared to the usual face-to-face treatment at the clinic. Despite this, a majority of the interview participants still expressed to have experienced various benefits from the treatment. Some participants did however, experience difficulties putting the materials to practical use. Furthermore, a large majority of the participants expressed a need for additional support, with a strong tendency for non-completers specifically expressing a need for face-to-face contact with a clinician. Implications for future research and implementation of iCBT in clinical practice are discussed.     

A transdisciplinary model integrating genetic, physiological, and psychological correlates of voluntary exercise.

OBJECTIVE: Physical inactivity contributes to as many as 250,000 premature deaths per year (R. R. Pate et al., 1995). The authors' objective was to test a transdisciplinary model of the ways in which genetic variants, physiological factors, and psychological factors are thought to influence exercise with 64 healthy, regular exercisers. DESIGN: In a within-subjects design, psychological and physiological responses to exercise were compared with responses to a sedentary activity. MAIN OUTCOME MEASURES: The authors measured affective state, perceived exertion, heart rate, and temperature change in response to moderate exercise versus sedentary activity. They also quantified genotypes on a single nucleotide polymorphism in the brain-derived neurotrophic factor (BDNF) gene. RESULTS AND CONCLUSIONS: The data show a relation between increases in positive affective states and acute exercise behavior, as opposed to a sedentary control. The BDNF gene moderated the effect of exercise on mood, heart rate, and perceived exertion. Physiological factors were, in turn, related to mood response, and mood response was a significant correlate of motivation to exercise in the future and of current exercise behavior. The model has potential as a framework for the basic study of the genetic, physiological, and psychological processes involved with voluntary exercise and as a tool for the applied examination of tailored exercise interventions and their efficacy for different subsets of individuals.     

Aberrant paralimbic gray matter in criminal psychopathy

Psychopaths impose large costs on society, as they are frequently habitual, violent criminals. The pervasive nature of emotional and behavioral symptoms in psychopathy suggests that several associated brain regions may contribute to the disorder. Studies employing a variety of methods have converged on a set of brain regions in paralimbic cortex and limbic areas that appear to be dysfunctional in psychopathy. The present study further tests this hypothesis by investigating structural abnormalities using voxel-based morphometry in a sample of incarcerated men (N=296). Psychopathy was associated with decreased regional gray matter in several paralimbic and limbic areas, including bilateral parahippocampal, amygdala, and hippocampal regions, bilateral temporal pole, posterior cingulate cortex, and orbitofrontal cortex. The consistent identification of paralimbic cortex and limbic structures in psychopathy across diverse methodologies strengthens the interpretation that these regions are crucial for understanding neural dysfunction in psychopathy.     

The roles of beaconing and dead reckoning in human virtual navigation

Beaconing is a process in which the distance between a visual landmark and current position is reduced in order to return to a location. In contrast, dead reckoning is a process in which vestibular, kinesthetic and/or optic flow cues are utilized to update speed of movement, elapsed time of movement, and direction of movement to return to a location. In the present experiment, human participants engaged in a virtual triangle-completion task devoid of vestibular cues in which they navigated two legs of an outbound path before homing (returning to the origin). However, our task was modified such that a landmark array was placed at the origin, allowing both beaconing and dead reckoning to be utilized to home. During the second leg of the outbound path, we manipulated aspects of the landmark array to determine the extent to which beaconing and dead reckoning influenced homing. Specifically, during probe trials, the landmark array either remained the same, shifted 3 or 6 meters east/west, or north/south, or was removed. We analyzed homing performance to determine the influence of landmark shifts on search behavior. Results suggested that participants were able to home with equal accuracy in both the presence and the absence of the landmark array. Array shifts that put beaconing and dead reckoning in conflict resulted in an averaging of the two sources of information for the determination of heading but a mixture of strategies for path length.