A double-blind,sham-controlled,trial of home-administered rhythmic 10-Hz median nerve stimulation for the reduction of tics,and suppression of the urge-to-tic,in individuals with Tourette syndrome and chronic tic disorder

Tourette syndrome (TS) and chronic tic disorder (CTD) are neurological disorders of childhood onset characterized by the occurrence of tics; repetitive, purposeless, movements or vocalizations of short duration which can occur many times throughout a day. Currently, effective treatment for tic disorders is an area of considerable unmet clinical need. We aimed to evaluate the efficacy of a home-administered neuromodulation treatment for tics involving the delivery of rhythmic pulse trains of median nerve stimulation (MNS) delivered via a wearable ‘watch-like’ device worn at the wrist. We conducted a UK-wide parallel double-blind sham-controlled trial for the reduction of tics in individuals with tic disorder. The device was programmed to deliver rhythmic (10 Hz) trains of low-intensity (1–19 mA) electrical stimulation to the median nerve for a pre-determined duration each day, and was intended to be used by each participant in their home once each day, 5 days each week, for a period of 4 weeks. Between 18th March 2022 and 26th September 2022, 135 participants (45 per group) were initially allocated, using stratified randomization, to one of the following groups; active stimulation; sham stimulation or to a waitlist (i.e. treatment as usual) control group. Recruited participants were individuals with confirmed or suspected TS/CTD aged 12 years of age or upward with moderate to severe tics. Researchers involved in the collection or processing of measurement outcomes and assessing the outcomes, as well as participants in the active and sham groups and their legal guardians were all blind to the group allocation. The primary outcome measure used to assess the ‘offline’ or treatment effect of stimulation was the Yale Global Tic Severity Scale–Total Tic Severity Score (YGTSS–TTSS) assessed at the conclusion of 4 weeks of stimulation. The primary outcome measure used to assess the ‘online’ effects of stimulation was tic frequency, measured as the number of tics per minute (TPM) observed, based upon blind analysis of daily video recordings obtained while stimulation was delivered. The results demonstrated that after 4-week stimulation, tic severity (YGTSS-TTSS) had reduced by 7.1 points (35 percentile reduction) for the active stimulation group compared to 2.13/2.11 points for the sham stimulation and waitlist control groups. The reduction in YGTSS–TTSS for the active stimulation group was substantially larger, clinically meaningful (effect size = .5) and statistically significant (p = .02) compared to both the sham stimulation and waitlist control groups, which did not differ from one another (effect size = −.03). Furthermore, blind analyses of video recordings demonstrated that tic frequency (tics per minute) reduced substantially (−15.6 TPM) during active stimulation compared to sham stimulation (−7.7 TPM). This difference represents a statistically significant (p < .03) and clinically meaningful reduction in tic frequency (>25 percentile reduction: effect size = .3). These findings indicate that home-administered rhythmic MNS delivered through a wearable wrist-worn device has the potential to be an effective community-based treatment for tic disorders.     

Hypertension differentially impacts cognition in men and women in early midlife

The current study aimed to understand how sex differences in the timing of hypertension onset contribute to early midlife risk for cognitive decline that may differ by sex and whether sex-dependent advantages in normotensive populations are influenced by the presence of hypertension. One hundred and ninety-five adults aged 45–55 from the New England Family Study underwent neuropsychological testing to assess attention, executive function, and memory. Physician-diagnosed hypertension status was self-reported via questionnaire. Mid-adulthood hypertension was associated with worse performance on measures of attention and memory, but the cognitive domains impacted varied by sex. Hypertension was associated with only attention in men, whereas in women it was associated with attention and associative and working memory. Sex differences in midlife cognitive performance found in normotensive adults were attenuated in those with hypertension. Our results underscore the importance of accounting for sex when assessing the impact of hypertension on midlife cognition that could be indicative of later decline and risk for cognitive impairment and dementia, given hypertension is an independent risk factor.     

Are moderate levels of stress particularly dangerous for relationship satisfaction? A conceptual replication of Tesser and Beach (1998)

The well-documented negative impact of daily stressors on relational well-being, juxtaposed with emerging evidence indicating that major stressors can have a positive impact on relational well-being, suggests that the association between stress and relational well-being may not be monotonic. Tesser and Beach originally raised this possibility in a 1998 study in which they found that the association between stress and individual well-being was linear, whereas the association with relational well-being was non-linear. The current study sought to conceptually replicate this study within the context of the COVID-19 pandemic by examining associations between stress and individual versus relational well-being, using a sample of 654 individuals who were in a committed relationship in the early weeks of the pandemic. Results were somewhat consistent with those of the original study: the association between stress and depression was linear, but the association between stress and relationship satisfaction was non-linear. However, the form of the association between stress and relationship satisfaction was different than observed in the original study. These results point toward the need to better understand how the severity of a stressor impacts relational outcomes, including the characteristics of stress that lead to stress spillover and the circumstances under which relational outcomes are resilient to high levels of stress.     

Direct and vicarious experiences of discrimination and rumination among Latinos before and during the beginning of the COVID-19 pandemic

People from racial/ethnic minority groups can experience discrimination in various ways, including both being the direct target of discrimination (directly experienced discrimination) and learning about others' experiences of discrimination (vicariously experienced discrimination). Additionally, the frequency of these experiences may change over time as larger societal changes occur. In this retrospective self-report study, we examined how Latinos' experiences of discrimination changed during the beginning of the COVID-19 pandemic, examining both direct and vicariously experienced discrimination, in real life and online. Participants reported significantly less discrimination in-person during the beginning of the pandemic relative to before the pandemic (both direct and vicarious), but no changes for direct or vicarious discrimination experienced online. We also examined changes in rumination, a maladaptive coping strategy thought to prolong negative effects of discrimination. Rumination was experienced more frequently than discrimination in general and increased during the beginning of the pandemic. Importantly, experiences of discrimination and rumination were related to mental health outcomes, including anxiety, depression, and loneliness.     

The “EA brief”: A single session of parent feedback and coaching to improve emotional attachment and emotional availability (EA)

The goal of this study was to determine the extent to which a brief parenting intervention provided the context for helping families to support positive mother–child interactions as well as more optimal mother and child outcomes. Participants in this study were middle income mothers and their children were between 0–3 years of age (N = 25 dyads). Participants were filmed via Skype during a 20-minute mother–child free play and completed questionnaires (Time 1) before attending the brief intervention (involving: a single session of one-on-one parent feedback and coaching, and information via group meeting, texts, and reading) followed by a repeat of the 20-minute Skype interaction and the completion of the same questionnaires (Time 2). Paired samples t-tests were performed, revealing that mothers reported improvements in their personal well-being (using the Flourishing Scale), reports about the mother-child relationship (using the Emotional Availability Self Report), and observed interactions, particularly the child's side of the relationship (using the Emotional Availability System), from pretest to posttest. Results are discussed in terms of a single session of parent feedback and coaching (in conjunction with an informational group session and texts) potentially having a role in “planting a seed” for observed and self-reported parenting enhancement and child development.     

Grieving the Earth as Prayer

The COVID-19 pandemic is not so much a new kind of crisis as our most recent reminder of the dysfunction of human relations with the world we inhabit. This article argues that transforming our relations with other creatures begins with an examination of the call to be human: understanding the kind of creature we are and therefore how to live alongside other creatures with natures distinct from our own. It critiques the tendency to overemphasize human distinctiveness (anthropocentrism) or creatureliness (biocentrism, ecocentrism) to the detriment of our interpretations of human nature. Employing Jean-Louis Chrétien’s phenomenology of prayer as wounded speech, it proposes that climate/ecological grief mediates the tension of our distance from and intimacy with other creatures. Speech expressing grief over the world therefore re-embeds humans in our finitude and contingency while nevertheless treating human nature as containing a particular call to participate in Christ’s transforming work.     

Best Practices for Counseling Clients Experiencing Poverty: A Grounded Theory

Poverty is a pressing sociopolitical issue in the United States and worldwide. Poverty experiences have a significant effect on one’s mental health and overall wellness. Therefore, the ability to effectively serve clients experiencing poverty is critically important to professional counselors. However, there are no empirical models for counseling clients experiencing poverty. The authors present the results of a constructivist grounded theory study in which 21 professional counselors who work with clients experiencing poverty were interviewed to identify best practices for working with this population. Five major best practices are identified: (a) awareness, (b) training, (c) knowledge, (d) skills, and (e) advocacy. Implications for professional counseling are included.     

The use of mixed modeling to evaluate the impact of treatment integrity on learning

Treatment integrity, or the degree to which an intervention is implemented as intended, is a critical feature of skill acquisition tasks. Single‐case design consistently demonstrates that low treatment integrity slows or inhibits learning, but the relative impact of different types of instructional errors, or the presence of multiple errors, is less clear. The present study utilized a multilevel modeling approach to evaluate the impact of type of error (omission versus omission and commission) and error component (reinforcer delivery versus feedback) on learning. Findings revealed that learning outcomes worsened based on the type of error and as the complexity of errors increased; more specifically, participants performed better when only a single type of error occurred and when only a single error component was manipulated. Additionally, individual characteristics contributed to learning outcomes, highlighting the use of multilevel modeling as a helpful tool to supplement single‐case design. The differential impact of integrity errors on learning may be due to timing of errors (i.e., commission errors more likely to occur early in learning) or how errors affect reinforcement schedule versus discriminative control.