High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: a prospective behavioral high-risk design

A prospective, behavioral high-risk design provided a theoretically guided examination of vulnerability to first onset of bipolar spectrum disorder based on the Behavioral Approach System (BAS) model. Adolescents (ages 14-19) at an "age of risk" for bipolar disorder onset were screened on BAS sensitivity by interviewers blind to current symptoms, lifetime history, and family history of psychopathology. Participants were selected with high versus moderate levels of BAS sensitivity and administered a lifetime diagnostic interview. Those with a bipolar spectrum disorder, psychosis, or hypomanic episode with onset prior to the BAS sensitivity assessment were excluded. High BAS (n = 171) and moderate BAS (n = 119) sensitivity participants in the final sample completed baseline measures of symptoms, goal-setting, and reward responsiveness and were followed prospectively with semistructured diagnostic interviews every 6 months. Consistent with the vulnerability hypothesis of the BAS model of bipolar disorder, high BAS participants had a greater likelihood, and shorter time to onset, of bipolar spectrum disorder than moderate BAS participants across an average of 12.8 months of follow-up (12.9% vs. 4.2%), controlling for baseline depressive and hypomanic symptoms, and family history of bipolar disorder. High reward responsiveness on a behavioral task and ambitious goal-striving for popular fame and financial success (but not impulsivity) also predicted first onset of bipolar spectrum disorder controlling for the covariates and BAS risk group, and ambitious goal-striving partially mediated the BAS risk group effect. We discuss implications of the findings for the BAS model of bipolar disorder and early intervention efforts.     

Progression along the bipolar spectrum: a longitudinal study of predictors of conversion from bipolar spectrum conditions to bipolar I and II disorders

Little longitudinal research has examined progression to more severe bipolar disorders in individuals with "soft" bipolar spectrum conditions. We examine rates and predictors of progression to bipolar I and II diagnoses in a nonpatient sample of college-age participants (n = 201) with high General Behavior Inventory scores and childhood or adolescent onset of "soft" bipolar spectrum disorders followed longitudinally for 4.5 years from the Longitudinal Investigation of Bipolar Spectrum (LIBS) project. Of 57 individuals with initial cyclothymia or bipolar disorder not otherwise specified (BiNOS) diagnoses, 42.1% progressed to a bipolar II diagnosis and 10.5% progressed to a bipolar I diagnosis. Of 144 individuals with initial bipolar II diagnoses, 17.4% progressed to a bipolar I diagnosis. Consistent with hypotheses derived from the clinical literature and the Behavioral Approach System (BAS) model of bipolar disorder, and controlling for relevant variables (length of follow-up, initial depressive and hypomanic symptoms, treatment-seeking, and family history), high BAS sensitivity (especially BAS Fun Seeking) predicted a greater likelihood of progression to bipolar II disorder, whereas early age of onset and high impulsivity predicted a greater likelihood of progression to bipolar I (high BAS sensitivity and Fun-Seeking also predicted progression to bipolar I when family history was not controlled). The interaction of high BAS and high Behavioral Inhibition System (BIS) sensitivities also predicted greater likelihood of progression to bipolar I. We discuss implications of the findings for the bipolar spectrum concept, the BAS model of bipolar disorder, and early intervention efforts.     

Leveraged Resources and Systems Changes in Community Collaboration

Most models of community collaboration emphasize the ability of diverse partners to come together to enact systematic changes that improve the health of individuals and communities. The ability of these groups to leverage resources is thought to be an important marker of successful collaboration and eventual improvements in community health. However, there is a paucity of research addressing linkages between systems change activities and leveraged resources. This study used a sample of collaboratives (N = 157) that received technical assistance and funding through the Georgia Family Connection Partnership (GaFCP) between 2006 and 2007. Data were collected from collaborative report of activities and funding, member ratings of collaborative functioning, and characteristics of the communities served by the collaboratives drawn from US Census data. Cross-lagged regression models tested longitudinal associations between systems change activities and leveraged dollars. The results indicated that systems change activities predict increased leveraging of resources from state/federal and private partners. However, there was no evidence that systems changes were linked with leveraging resources from local groups and agencies. These findings have important implications for providing technical assistance and training to health partnerships. Furthermore, future research should consider the relative strength of different systems change activities in relation to the ability of coalitions to leverage resources.     

A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: multiple pathways to self-injurious thinking

In order to advance the detection and prevention of suicide, recent research has focused on predictors of suicidal ideation and behavior such as negative cognitive styles, dysfunctional attitudes, hopelessness, and rumination. In this study the relationships among these risk factors in the context of the Attention Mediated Hopelessness (AMH) theory of depression are examined. One hundred and twenty-seven undergraduates in the Cognitive Vulnerability to Depression (CVD) project were followed for 2.5 years. The CVD project followed initially nondepressed freshmen, at either high or low cognitive risk for depression, in order to predict onsets and recurrences of depressive disorders. The presence and duration of suicidal ideation were predicted prospectively by rumination and hopelessness, and hopelessness partially mediated the relationship between rumination and ideation and fully mediated the association between rumination and duration of suicidality. Further, rumination mediated the relationship between cognitive vulnerability and suicidal ideation.     

Observing behavior and atypically restricted stimulus control

Restricted stimulus control refers to discrimination learning with atypical limitations in the range of controlling stimuli or stimulus features. In the study reported here, 4 normally capable individuals and 10 individuals with intellectual disabilities (ID) performed two-sample delayed matching to sample. Sample-stimulus observing was recorded with an eye-tracking apparatus. High accuracy scores indicated stimulus control by both sample stimuli for the 4 nondisabled participants and 4 participants with ID, and eye tracking data showed reliable observing of all stimuli. Intermediate accuracy scores indicated restricted stimulus control for the remaining 6 participants. Their eye-tracking data showed that errors were related to failures to observe sample stimuli and relatively brief observing durations. Five of these participants were then given interventions designed to improve observing behavior. For 4 participants, the interventions resulted initially in elimination of observing failures, increased observing durations, and increased accuracy. For 2 of these participants, contingencies sufficient to maintain adequate observing were not always sufficient to maintain high accuracy; subsequent procedure modifications restored it, however. For the 5th participant, initial improvements in observing were not accompanied by improved accuracy, an apparent instance of observing without attending; accuracy improved only after an additional intervention that imposed contingencies on observing behavior. Thus, interventions that control observing behavior seem necessary but may not always be sufficient for the remediation of restricted stimulus control.     

The Leftward Cradling Bias and Prosody: An Investigation of Cradling Preferences in the Deaf Community

Popular theory on the tendency to cradle an infant to the left side points to the specialization of the right hemisphere for the perception and expression of emotion. J. S. Sieratzki and B. Woll (1996) recently suggested that more emphasis be placed on the auditory modality, specifically focusing on the role of prosodic information. In this study, the direction of the lateral cradling bias in a group of profoundly deaf children, a group of deaf adults, and a control group of adults with no hearing impairment was investigated. The authors found a strong leftward cradling bias in all groups, a bias that was, if anything, stronger in the deaf participants. Given that people who are profoundly deaf, especially those who have been deaf from birth, have not been exposed to auditory prosody, the data do not support the suggestion that such prosodic information is the basis for the leftward cradling bias.     

Chain letters: Players and their accounts

Even though it is unlawful to send chain letters through the mails, thousands of Americans send them to friends, acquaintances, and strangers in hopes that their names will move to the top of the pyramid, and they will receive the influx of tax‐free dollars from those at the bottom of the chain. This paper analyzes the content and structure of the chain letter and also describes the accounts which chain letter players (N=129) provide for their participation. Differences between male and female accounts and participation strategies are provided. The implications for these differences for understanding participation in the underground economy are discussed.     

Facilitated Disclosure Versus Clinical Accommodation of Infidelity Secrets: An Early Pivot Point in Couple Therapy. Part 2: Therapy Ethics,Pragmatics, and Protocol

In couple therapy, one partner's private disclosure of infidelity presents a potentially polarizing issue involving the therapist's decision to facilitate disclosure or accommodate non-disclosure. Some therapists may assume accommodating an infidelity secret is the most compassionate and efficient option. We consider this decision in the context of therapy ethics of equal advocacy and confidentiality, implications for individual and relationship healing, and pragmatic aspects of conducting therapy. We conclude that measured disclosure of infidelity, determined by the aggrieved spouse, best resolves the potential collision of multilateral advocacy with confidentiality and offers the best prospects for a working therapy alliance and couple healing and renewal. A clinical protocol for facilitating disclosure of infidelity secrets is presented.