Avoidant coping in panic disorder: a yohimbine biological challenge study

Abstract

Few studies have addressed whether the use of avoidance-oriented coping strategies is related to the development of panic in patients with panic disorder(PD). Self-report, clinician-rated, and physiological data were collected from 42 individuals who participated in a yohimbine biological challenge study, performed under double-blind, placebo-controlled conditions. Participants included 20 healthy controls and 22 currently symptomatic patients who met DSM-IV-TR diagnostic criteria for PD. Consistent with prediction, patients with PD who had higher perceived efficacy of avoidance-oriented strategies in reducing anxiety-related thoughts reported increased severity in panic symptoms during the yohimbine challenge condition as compared to the placebo. Further, patients with PD who had more fear of cognitive dyscontrol, cardiovascular symptoms, and publicly observable anxiety also reported increased severity in panic symptoms during the challenge. Healthy controls who had more fear of cardiovascular symptoms similarly reported increased severity in panic symptoms during the challenge. No effects were found for heart rate response to the challenge agent. These results provide support for the role of avoidance-oriented coping strategies and fear of anxiety-related symptoms as risk and maintenance factors in the development of panic symptoms, particularly within a biological challenge model.     

Methodological Challenges in Causal Research on Racial and Ethnic Patterns of Cognitive Trajectories: Measurement, Selection, and Bias

Research focused on understanding how and why cognitive trajectories differ across racial and ethnic groups can be compromised by several possible methodological challenges. These difficulties are especially relevant in research on racial and ethnic disparities and neuropsychological outcomes because of the particular influence of selection and measurement in these contexts. In this article, we review the counterfactual framework for thinking about causal effects versus statistical associations. We emphasize that causal inferences are key to predicting the likely consequences of possible interventions, for example in clinical settings. We summarize a number of common biases that can obscure causal relationships, including confounding, measurement ceilings/floors, baseline adjustment bias, practice or retest effects, differential measurement error, conditioning on common effects in direct and indirect effects decompositions, and differential survival. For each, we describe how to recognize when such biases may be relevant and some possible analytic or design approaches to remediating these biases.     

System-of-Care Practice Review Scores as Predictors of Behavioral Symptomatology and Functional Impairment

The longitudinal comparison study of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program assesses factors in service delivery systems that may shape the impact of systems of care. We evaluated the extent to which services embodying the principles of a system of care, as measured by the System-of-Care Practice Review (SOCPR), affect clinical outcomes for children being served in federally-funded systems of care and matched comparison communities. The participants included 75 children and families selected for participation in the SOCPR. Results indicated that experience of services embodying system-of-care principles at a high level was associated with lower symptom and impairment scores one year after entry into services. Children in systems of care were rated to have experienced high levels of system-of-care principles implemented within their services, and their symptom severity and functional impairment did not vary as a function of their experiences. Children in matched comparison communities had more variable rated experiences of system-of-care principles within their services, and their symptom severity and functional impairment decreased as their experiences of the principles increased.     

Who's Watching the Race? Racial Salience in Recruitment Advertising1

A recent finding (Thomas & Wise, 1999) suggested that the race of organizational representatives may be more important to minority applicants than to White applicants. Consequently, this study empirically examines the impact of race in recruitment advertising on applicant attraction. Participants (N= 194) were recruited in 3 field settings and were exposed to recruitment literature varying the race of a depicted organizational representative. Results indicate that Black and Hispanic participants were more attracted when minority representatives were depicted; White participants' reactions were unaffected by representative race. Moreover, the extent to which participants believed themselves to be similar to the representative fully mediated the effect for minority participants.     

A Developmental Framework for Collaboration in Child-Serving Agencies

Collaboration for the purpose of interdependent problem solving represents a fundamental reform of services for children with serious emotional disturbance and their families, which have typically been categorical, poorly coordinated, costly, overly restrictive, and frequently provided outside of the children's home communities. This article presents a developmental framework for collaboration that is based on the experience of families, service providers, administrators, and community members who have been involved in local collaborative processes in their own communities. The framework provides those interested in building collaboration a clear identification of the stages of collaborative development, defining characteristics of each stage, collaborative activities typical of that stage, and identification of the catalyst for change to the next stage. The results of this project indicate that while well-developed professional collaboration is a necessary component of collaboration, it is not sufficient in and of itself. The sites participating in this project related their experiences in building collaborative processes to both the development of strong interagency collaborations and the development of family participation. Their experience indicates that these two processes must be fully developed and woven together to achieve the goal of true collaboration.     

How Do Master's Level Marriage and Family Therapy Students View Their Basic Therapy Skills? An Examination of Generic and Theory Specific Clinical Approaches to Family Therapy

This study examined the similarities and differences between marital and family therapy (MFT) students' beliefs about the importance of specific MFT skills, and the perceptions of experienced therapists in practice about the same skills. The data suggest overlap but not complete agreement between the perceptions of novice and experienced therapists regarding both generic and theory specific skills. Similarities and differences between these findings and earlier research about common factors in family therapy are addressed. Recommendations about clinical training that is not organized around traditional family therapy theories, but rather based on two trans-theoretical approaches to therapy labeled expert and collaborative are explored.     

Self-projection in younger and older adults: a study of episodic memory,prospection, and theory of mind

Self-projection is the ability to orient the self in different places in time and space. Episodic memory, prospection, and theory of mind (ToM) are all cognitive abilities that share an element of self-projection. Previous research has posited that each of these abilities stems from the same neural network. The current study compared performance of cognitively healthy older adults and younger adults on several self-projection tasks to examine the relatedness of these constructs behaviorally. Episodic memory and prospection were measured using an episodic interview task where the participants were asked to remember or imagine events that either had happened in the past or could happen in the future and then gave ratings describing the extent to which they were mentally experiencing the event and from what perspective they viewed it. ToM was measured by asking participants to make judgments regarding the intentions of characters described in stories that involved cognitive, affective, or ironic components. Our results demonstrate that aging influences episodic memory, prospection, and ToM similarly: older adult participants showed declines on each of these measures compared to younger adults. Further, we observed correlations between performance on the measures of episodic memory and prospection as well as between episodic memory and ToM, although no correlation between prospection and ToM was observed after controlling for chronological age. We discuss these results in the light of theories suggesting that each of these abilities is governed by a common brain system.     

Does client self‐booking reduce ‘did not attends’ (DNAs) in a counselling service?

An important problem for our counselling service is the high number of clients who ‘did not attend’ (DNA) for their booked appointment. This paper aims to describe how we tackled this problem within our counselling service by using a Plan‐Do‐Study‐Act (PDSA) cycle (Langley, Nolan Norman and Provost, 1996). The results found that by devising a system whereby clients could self‐book their appointments we were able to reduce the DNA rate for first appointments from 31.70% to 2%. This has useful time and financial implications. We would expect that the self‐booking approach we have outlined here is adaptable for other counselling services.