Distress tolerance but not impulsivity predicts outcome in concurrent treatment for posttraumatic stress disorder and substance use disorder

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) commonly co-occur. Emerging research suggests that both distress tolerance and impulsivity may underlie this comorbidity. However, to our knowledge no studies have examined whether these 2 constructs predict outcome in PTSD-SUD treatment. The current study investigated whether pretreatment distress tolerance and impulsivity predicted posttreatment PTSD and cravings severity in a sample of 70 Veterans receiving concurrent treatment for PTSD and SUD in a residential day treatment program. Veterans completed measures of symptom severity before and after treatment. Results demonstrated that pretreatment distress tolerance predicted posttreatment PTSD severity while controlling for pretreatment PTSD. By contrast, pretreatment impulsivity was not predictive of posttreatment PTSD while controlling for pretreatment values. Neither distress tolerance nor impulsivity predicted posttreatment cravings severity. The findings support the notion that distress tolerance may help to explain the co-occurrence of PTSD and SUD and suggest that targeting this construct in PTSD-SUD treatment may be important for successful outcomes.     

Factor structure of the primary scales of the Inventory of Personality Organization in a nonclinical sample using exploratory structural equation modeling

Using exploratory structural equation modeling and multiple regression, we examined the factor structure and criterion relations of the primary scales of the Inventory of Personality Organization (IPO; Kernberg & Clarkin, 1995) in a nonclinical sample. Participants (N = 1,260) completed the IPO and measures of self-concept clarity, defenses, affect and emotion regulation, and risky and self-injurious behavior. In contrast to that of Lenzenweger, Clarkin, Kernberg, and Foelsch (2001), a 4-factor measurement model was derived with factors representing instability of sense of self and other, instability of goals, instability of behaviors, and psychosis. The 1st of these factors related most strongly to external measures of self-concept clarity, defenses, and affect, whereas the 3rd factor related most strongly to measures of risky behavior and self-injury. These results suggest that the IPO's factor structure does not conform to the hypothesized 3-factor model, although it does capture important elements of Kernberg's (1996) theory of personality organization, especially the central construct of representations of self and others. The results point to several areas in which the IPO might be refined to provide a more comprehensive and theoretically appropriate measure of the borderline personality organization construct.     

Peer pressure against prejudice: A high school field experiment examining social network change

Individuals often conform to the intergroup attitudes and behaviors modeled by their peers in a given situation. To what extent does peer influence on intergroup prejudice 1) diffuse across a social network of peers and 2) affect attitudes and behavior across time? Student leaders (“Peer Trainers”) were trained to confront expressions of intergroup prejudice in five randomly assigned high schools across a period of five months; students recruited to be Peer Trainers in five control schools waited to be trained. Independent surveys of Peer Trainers' social networks reveal that treatment Peer Trainers were significantly more likely than control Trainers to be nominated by peers as students who confront prejudice. Treatment Peer Trainers' tolerant behavior spread to close friends and to acquaintances in their social network; their attitudes spread inconsistently, and only to close friends. Studying peer influence within social networks can improve understanding of social influence, prejudice reduction, and social change.     

Modeling the effect of reward amount on probability discounting

The present study with college students examined the effect of amount on the discounting of probabilistic monetary rewards. A hyperboloid function accurately described the discounting of hypothetical rewards ranging in amount from $20 to $10,000,000. The degree of discounting increased continuously with amount of probabilistic reward. This effect of amount was not due to changes in the rate parameter of the discounting function, but rather was due to increases in the exponent. These results stand in contrast to those observed with the discounting of delayed monetary rewards, in which the degree of discounting decreases with reward amount due to amount-dependent decreases in the rate parameter. Taken together, this pattern of results suggests that delay and probability discounting reflect different underlying mechanisms. That is, the fact that the exponent in the delay discounting function is independent of amount is consistent with a psychophysical scaling interpretation, whereas the finding that the exponent of the probability-discounting function is amount-dependent is inconsistent with such an interpretation. Instead, the present results are consistent with the idea that the probability-discounting function is itself the product of a value function and a weighting function. This idea was first suggested by Kahneman and Tversky (1979), although their prospect theory does not predict amount effects like those observed. The effect of amount on probability discounting was parsimoniously incorporated into our hyperboloid discounting function by assuming that the exponent was proportional to the amount raised to a power. The amount-dependent exponent of the probability-discounting function may be viewed as reflecting the effect of amount on the weighting of the probability with which the reward will be received.     

The Patient–Doctor Relationship Questionnaire (PDRQ-9) in Primary Care: A Validity Study

This study assessed the validity of the Patient–Doctor Relationship Questionnaire-9 (PDRQ-9) in a primary care sample (N = 180). Convergent validity was assessed through a correlation between the patient-rated PDRQ-9 and the physician-rated Difficult Doctor Patient Relationship Questionnaire-10 (DDPRQ-10). Discriminant validity was assessed through correlations between the PDRQ-9 and patient age, patient- and physician-reported health and psychological distress. To determine if the PDRQ-9 could discriminate between groups, patient PDRQ-9 ratings were compared between patients who were treated by faculty physicians versus those who were treated by residents. An exploratory factor analysis confirmed that the PDRQ-9 was made up of a single factor. The PDRQ-9 scale was internally consistent (α = .96) and significantly and negatively correlated with the DDPRQ-10 (r = ?.22, p = .003) and was not significantly correlated with patient age, health, or psychological distress. PDRQ-9 ratings were statistically greater in patients who were treated by faculty physicians than those who were treated by residents (p = .01). This study provides additional support for the reliability and validity of the PDRQ-9 as a measure of the doctor–patient relationship in a primary care sample.     

Illness Perception Differences Between Russian- and Hebrew-Speaking Israeli Oncology Patients

Illness perception influences health and illness behaviors. This study was designed to estimate illness perception differences between Russian-speaking and Hebrew-speaking Israeli oncology patients. Changes in illness perception associated with time spent in Israel among Russian-speaking patients were also evaluated. Additionally, we evaluated differences in illness perception of patients exposed to Chernobyl’s consequences. A total of 144 oncology patients (77 Hebrew-speaking, 67 Russian-speaking) completed personal data questionnaires and The illness perception questionnaire revised, translated into Russian for this study. Significantly more Russian-speaking oncology patients perceived their illness as chronic and having negative consequences on life (p < .01). Russian-speaking oncology patients tend to have a more negative perception of cancer compared to Hebrew-speaking patients. Time spent in Israel may create more positive perceptions of cancer among these patients. No illness perception differences were found concerning Chernobyl consequences.     

Is Neurolaw Conceptually Confused?

In Minds, Brains, and Law, Michael Pardo and Dennis Patterson argue that current attempts to use neuroscience to inform the theory and practice of law founder because they are built on confused conceptual foundations. Proponents of neurolaw attribute to the brain or to its parts psychological properties that belong only to people; this mistake vitiates many of the claims they make. Once neurolaw is placed on a sounder conceptual footing, Pardo and Patterson claim, we will see that its more dramatic claims are false or meaningless, though it might be able to provide inductive evidence for particular less dramatic claims (that a defendant may be lying, or lacks control over their behavior, for instance). In response, I argue that the central conceptual confusions identified by Pardo and Patterson are not confusions at all. Though some of the claims made by its proponents are hasty and sometimes they are confused, there are no conceptual barriers to attributing psychological properties to brain states. Neuroscience can play a role in producing evidence that is more reliable than subjective report or behavior; it therefore holds out the possibility of dramatically altering our self-conception as agents and thereby the law.