Brief Behavioral Therapy for Pediatric Anxiety and Depression: Piloting an Integrated Treatment Approach

Mood and anxiety disorders in youth are disabling, distressing, and prevalent. Furthermore, depression and anxiety frequently co-exist, may share several etiological factors, and respond to similar interventions. In this paper, we report preliminary results from a treatment adaptation project designed to condense existing cognitive behavioral therapy protocols for anxiety and depression to their core components and combine them into a brief, integrated treatment suitable for the broad population of internalizing youth seen in primary care. Specifically, we discuss: (a) the rationale for targeting anxiety and depression in pediatric primary care and the deployment-focused treatment development model; (b) the content of our behaviorally based treatment program; and (c) clinical outcomes of 2 sample cases with comorbid depression and anxiety.     

Differential role of the hippocampal endocannabinoid system in the memory consolidation and retrieval mechanisms

CB1 cannabinoid receptors are abundantly expressed in the brain, with large concentrations present in the hippocampus, a brain structure essential for memory processing. In the present study, we have investigated the possible modulatory role of the endocannabinoid system in the dorsal hippocampus upon the different phases of memory processing of an aversive task. AM251, a selective antagonist of CB1 receptors, and anandamide, an endogenous agonist of cannabinoid receptors, were bilaterally infused into the dorsal hippocampus of male Wistar rats either before training, immediately after training, or before test in the step-down inhibitory avoidance (IA) task. Results showed that pre-training infusion of CB1 drugs did not influence the acquisition of the task. In contrast, post-training infusion of the CB1 antagonist disrupted while the antagonist facilitated memory consolidation of IA. The post-training results demonstrate that memory consolidation depends on the integrity of the endocannabinoid system in the CA1 region of the dorsal hippocampus. While we still have no direct proof of endocannabinoids released there after an aversive task such as IA, these results suggests that (a) AM251 acts blocking the binding of endogenously released cannabinoids and (b) exogenously supplemented anandamide may be adding its contribution to the action of the endogenously released pool. Considering our data and the higher density of CB1 receptors present in the GABAergic interneurons, we propose them as the putative target of the endocannabinoid modulation of memory, a hypothesis that needs to be proven. In addition, pre-test infusion of the CB1 receptor antagonist facilitated while infusion of the agonist did not affect memory retrieval of IA. The completely opposite action of the same drug upon memory at the post-training (consolidation) and pre-test (recall) contexts suggests that some durable change took place in the CA1 region during the consolidation process that modified the logical attributes of the pharmacological response, i.e., the drug response changed from memory disruption to memory facilitation. A similar phenomenon was previously described by us in the M4 cholinergic muscarinic subsystem in the hippocampus for the same task (Diehl, F., Fürstenau, L. O., Sanchez, G., Camboim, C., de Oliveira Alvares, L., Lanziotti, V. B., et al. (2007). Facilitatory effect of the intra-hippocampal pretest administration of MT3 in the inhibitory avoidance task. Behavioral Brain Research, 177(2), 227-231), but the biological nature of such change in the local neural circuitry remains to be investigated.     

Typing letter strings varying in orthographic structure

Subjects typed six-letter strings varying in orthographic structure. Lexical status, word frequency, position-sensitive log bigram frequency, and regularity of letter sequencing were systematically varied. Cumulative reaction times (RTs) of the keystrokes were adequately described by a linear function of letter position in the test string. Overall, words were typed faster than nonwords, and regular strings faster than irregular strings. Although the effect of log bigram frequency was not significant, this variable interacted with regularity and word frequency. Post hoc analyses of performance on each of the 200 letter strings revealed significant effects of the number of irregularities, log bigram frequency, and log word frequency. Transition times between successive keystrokes were significantly longer for illegal than for legal letter transitions. These results are similar to previous findings on the role of orthographic structure in the perceptual recognition of letter strings and provide a more complete analysis of context effects in typing.     

The effects of explicit “Not Present” and “Don't Know” response options on identification decisions in computer-administered lineups

Eyewitness researchers recommend that “not present” and “don't know” response options should be presented with police lineups. Although it is important that witnesses—most of whom are unlikely to be familiar with the identification task—are fully cognizant of all response options available to them, an understanding of how explicit non-identification options affect performance is lacking. Across four experiments, including 3,633 participants and 8 different stimulus sets, we tested the effects of including non-identification options in computer-administered lineups. When explicit non-identification options were presented, target-present and -absent choosing decreased. This decrease in choosing was characterized by a shift from filler identifications to lineup rejections. ROC analyses revealed that there was no overall difference in discriminability between guilty and innocent suspects depending on response option condition. On balance, the findings suggest that, in addition to informing witnesses about acceptable responses, displaying non-identification response options does not undermine identification performance.