Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety

Internet-based cognitive behavior therapy (CBT) for severe health anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe health anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state health anxiety, b) improvement in health anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state health anxiety and improvement were baseline health anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, health anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe health anxiety.     

Poor motor skills: A risk marker for bully victimization

Children who are clumsy are often bullied. Nevertheless, motor skills have been overlooked in research on bullying victimization. A total of 2,730 Swedish adults (83% females) responded to retrospective questions on bullying, their talents in physical education (i.e., coordination and balls skills) and school academics. Poor talents were used as indicators of poor gross motor skills and poor academic skills. A subset of participants also provided information on educational level in adulthood, childhood obesity, belonging to an ethic minority in school and socioeconomic status relative to schoolmates. A total of 29.4% of adults reported being bullied in school, and 18.4% reported having below average gross motor skills. Of those with below average motor skills, 48.6% were bullied in school. Below average motor skills in childhood were associated with an increased risk (OR 3.01 [95% CI: 1.97–4.60]) of being bullied, even after adjusting for the influence of lower socioeconomic status, poor academic performance, being overweight, and being a bully. Higher odds for bully victimization were also associated with lower socioeconomic status (OR 2.29 [95% CI: 1.45–3.63]), being overweight (OR 1.71 [95% CI: 1.18–2.47]) and being a bully (OR 2.18 [95% CI: 1.53–3.11]). The findings indicate that poor gross motor skills constitute a robust risk‐marker for vulnerability for bully victimization. Aggr. Behav. 39:453–461, 2013. © 2013 The Authors. Aggressive Behavior Published by Wiley‐Blackwell     

Long-Term Outpatient Treatment in Alcoholics with Previous Suicidal Behavior

The importance of previous suicidal behavior for the treatment of alcoholics was analyzed in a long-term outpatient treatment study. In a series of 72 patients, 21 patients, (29%), 17 men and 4 women, had previously made at least one suicide attempt or had seriously threatened to kill themselves (3 cases). In comparison with the other alcoholics, those with previous suicidal behavior had a similar attrition rate, they were not more troublesome in treatment, and they had the same rate of favorable outcome during the third year after start of treatment. They differed from the other alcoholics in having a more severe abuse and a less favorable outcome during the initial part of the treatment. In conclusion, our results support the possibility of a long-term outpatient treatment strategy in alcoholics with previous suicide attempts.     

It Pays to Pay Attention: A Mindfulness-Based Program for Injury Prevention With Soccer Players

The aim of this study was to examine the extent to which a mindfulness-based program could reduce the number of sport injuries in a sample of soccer players. A total of 41 junior elite soccer players were randomly assigned to the treatment or the attentional control group. The treatment group took part in a 7-session program based on the mindfulness, acceptance, and commitment approach. The attentional control group was offered 7 sessions of sport psychology presentations with a particular focus on soccer. There were no statistically significant differences in injury rates between the two groups, U(39) = 149.50, z = ?1.77, p =.077, but there was a medium effect size (adjusted Cohen's d = ? 0.59), approx. 80% confidence interval for d [?0.37, ?0.74]. Moreover, 67% of the players in the mindfulness group remained injury free in comparison to 40% in the control group. This result implies that an intervention program focusing on strategies for improving attention could decrease injury risk. Recommendations include applying mindfulness exercises in athletes’ daily training to help lower injury risk.     

Psychometric evaluation and further validation of the Hagedoorn et al. modified EVLN measure

The aim of the present study was to evaluate and further validate a modified Exit, Voice, Loyalty and Neglect (EVLN) instrument (Hagedoorn, Van Yperen, Van de Vliert & Buunk, 1999), in a Swedish sample (n= 792). To test the underlying scaling assumptions, the convergent and divergent validity, a multitrait/multi-item analysis was conducted and factor analyses were used to evaluate the factor structure. The concurrent validity was tested by using the modified EVLN instrument as predictor and three different forms of justice as criteria in the analysis. The criterion-related validity was tested and an association between exit behavioral response and actual exit behavior was found (predictive validity). The results showed that the instrument may be considered to be a valid measure with the exception of the aggressive voice scale.     

Examining Relations between Aging,Life Story Chapters,and Well‐Being

Socio‐emotional selectivity theory holds that older age is associated with a sense of limited remaining time. We suggest that life story chapters may be involved in this experience. In this first study on the connection between socio‐emotional selectivity theory and chapters, we examined whether older age is associated with fewer, temporally less distant, and less positive future chapters. We also examined relations between chapters and subjective well‐being. Two samples (18–84 years) described past and future chapters and completed well‐being measures. Older age was associated with fewer, less temporally extended, and less positive future chapters. Less positive past chapters was most consistently related to lower subjective well‐being, but less positive future chapters also predicted lower subjective well‐being in some analyses. Copyright © 2017 John Wiley & Sons, Ltd.     

Brain dynamics associated with face-naming and the tip-of-the-tongue state

Active brain areas and their temporal sequence of activation during the successful retrieval and naming of famous faces (KNOW) and during the tip-of-the-tongue (TOT) state were studied by means of low resolution electromagnetic tomographic analysis (LORETA) applied to event-related potentials. The results provide evidence that adequate activation of a neural network during the first 500 ms following presentation of the photograph--mainly involving the posterior temporal region, the insula, lateral and medial prefrontal areas and the medial temporal lobe--is associated with successful retrieval of lexical-phonological information about the person's name. Significant differences between conditions were observed in the 538-698-ms interval; specifically there was greater activation of the anterior cingulate gyrus (ACC) towards the supplementary motor area (SMA) in the KNOW than in the TOT condition, possibly in relation to the motor response and as a consequence of the successful retrieval of lexical-phonological information about the person.     

Variables associated with repeated suicide attempt in a criminal justice population

The aim of this study was to identify factors associated with repeated suicide attempts among criminal justice clients examined for substance abuse using the Addiction Severity Index. Among suicide attempters (n=1,404), repeaters (two or more attempts, n=770) were compared to nonrepeaters. In logistic regression, repetition was associated with younger age, opioid analgesics, somatic medication, overdose, maternal psychiatric problems, delirium tremens, cognitive problems, and violent behavior. As in other settings, factors associated with repetition differed from those associated with suicide attempts in general. In this setting, substance use complications and cognitive problems were connected to repetition and should be addressed in risk assessments.