Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.     

“Going the Extra Mile”: Disclosure,Accommodation, and Stigma Management among Working Women with Disabilities

ABSTRACT

Although research has quantitatively evaluated the impacts of stigma upon working women with disabilities (WWD), nuanced, qualitative accounts voiced by these women are rare. To address this literature gap, we conducted seven focus groups with 42 WWD. We asked: “What are women’s experiences of disability disclosure and accommodation in the workplace?” Findings reveal that WWD face intentional and unintentional structural discrimination and must weigh the pros and cons of disclosure and navigate devaluation threats in pursuing workplace accommodations. “Going the extra mile” emerged as a stigma management technique which was prevalent among women of higher social capital.     

The differential effect of team members' trust on team performance: The mediation role of team cohesion

This study examines team performance as affected by various trusting relationships: trust between team members and the team's trust in their direct manager and in top management. Data for the study were collected from a survey of 690 professional elite athletes (belonging to 59 different sports clubs) playing in the regular, top professional Spanish leagues. The model was tested at the team level. Findings reveal that team member trust with respect to the different foci has both a direct and indirect effect on team performance, and that team player trust and cohesion play a mediating role. This study illustrates the dynamic relationship within teams, and, as such, trust among teammates mediates the relationship between trust in the coach as well as team cohesion in determining team performance. The implications for managing teams in other contexts are also evaluated.     

Effects of loss aversion on post-decision wagering: Implications for measures of awareness

Wagering contingent on a previous decision, or post-decision wagering, has recently been proposed to measure conscious awareness. Whilst intuitively appealing, it remains unclear whether economic context interacts with subjective confidence and how such interactions might impact on the measurement of awareness. Here we propose a signal detection model which predicts that advantageous wagers placed on the identity of preceding stimuli are affected by loss aversion, despite stimulus visibility remaining constant. This pattern of predicted results was evident in a psychophysical task where we independently manipulated perceptual and economic factors. Changes in wagering behaviour induced by changes in wager size were largely driven by changes in criterion, consistent with the model. However, for near-threshold stimuli, a reduction in wagering efficiency was also evident, consistent with an apparent but potentially illusory decrease in awareness of the stimulus. These findings challenge an assertion that post-decision wagering provides a direct index of subjective awareness.     

Nonlinear epigenetic variance: review and simulations

We present a review of empirical evidence that suggests that a substantial portion of phenotypic variance is due to nonlinear (epigenetic) processes during ontogenesis. The role of such processes as a source of phenotypic variance in human behaviour genetic studies is not fully appreciated. In addition to our review, we present simulation studies of nonlinear epigenetic variance using a computational model of neuronal network development. In each simulation study, time series for monozygotic and dizygotic twins were generated and analysed using conventional behaviour genetic modelling. In the results of these analyses, the nonlinear epigenetic variance was subsumed under the non-shared environmental component. As is commonly found in behaviour genetic studies, observed heritabilities and unique environmentabilities increased with time, whereas common environmentabilities decreased. The fact that the phenotypic effects of nonlinear epigenetic processes appear as unsystematic variance in conventional twin analyses complicates the identification and quantification of the ultimate genetic and environmental causes of individual differences. We believe that nonlinear dynamical system theories provide a challenging perspective on the development of individual differences, which may enrich behaviour genetic studies.     

Severity Indices of Personality Problems (SIPP-118): development, factor structure, reliability, and validity

This article describes a series of studies involving 2,730 participants on the development and validity testing of the Severity Indices of Personality Problems (SIPP), a self-report questionnaire covering important core components of (mal)adaptive personality functioning. Results show that the 16 facets constituted homogeneous item clusters (i.e., unidimensional and internally consistent parcels) that fit well into 5 clinically interpretable, higher order domains: self-control, identity integration, relational capacities, social concordance, and responsibility. These domains appeared to have good concurrent validity across various populations, good convergent validity in terms of associations with interview ratings of the severity of personality pathology, and good discriminant validity in terms of associations with trait-based personality disorder dimensions. Furthermore, results suggest that the domain scores are stable over a time interval of 14-21 days in a student sample but are sensitive to change over a 2-year follow-up interval in a treated patient population. Taken together, the final instrument, the SIPP-118, provides a set of 5 reliable, valid, and efficient indices of the core components of (mal)adaptive personality functioning.     

Cognitive coping strategies and blood pressure responses to real-life stress in healthy young men.

Coping style is an important feature in the understanding of the relation between real-life stress and associated blood pressure (BP) responses. In this study, 10 high- and 10 low-"self-focused-coping" (SFC) male college students were tested with ambulatory BP monitoring on two typical schooldays, one of which included an examination. It was found that the high-SFC subjects, defined as those who tend to keep to themselves and/or blame themselves in stressful situations, showed higher BP responses than the low-SFC subjects, but only on the exam day. Further, the high-SFC subjects showed higher BP during the exam but also had BP elevations that were sustained during other activities throughout the same day, including evening rest. These results are discussed in terms of the relation between psychological and physiological responding.     

Persons, situations, and time: a genetic view of behavioral change in children.

Twin children participating in a longitudinal study were observed at 9, 12, 18, 24, and 30 months of age in two settings: unstructured free play and relatively structured test taking. Behaviors relating to adaptability to the two settings were rated and the scores analyzed for evidence of continuity both across settings and across ages. Age-to-age correlations for the adaptability scores for each setting yielded a simplex pattern of low-moderate order. Correlations of individuals' scores across settings were also of low-moderate order. Within-pair correlations indicated that identical twins were more similar that same-sex fraternal twins in both settings, but correlations were consistently stronger in the playroom setting. Analysis of variance was performed to test for within-pair concordance in the direction and degree of change. Identical pairs remained significantly more similar in adaptability from one setting to another even when change in adaptability occurred. Similar results were found for change across ages; however, these differences were significant only in the playroom setting. Results suggest that situation variables contribute to the low stabilities frequently reported for personality dimensions but that the direction and degree of behavioral change are genetically conditioned.