Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research

Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.     

Advice seeking and loaning of money related to relapse in recovery homes

Recovery homes help individuals who have completed substance use treatment programs re‐integrate back into the community. However, it is unclear what factors determine who will succeed in these settings and how these factors may be reinforced or undermined by the social interactions and social networks between residents living in the Oxford House recovery homes. In an effort to better understand these factors, the current study evaluated (a) the extent to which the density of social networks (i.e., friendship, willingness to loan money, and advice‐seeking relationships) is associated with social capital (i.e., sense of community, quality of life, hopefulness, self‐efficacy), and (b) whether the density of social networks predicts relapse over time. Among the findings, willingness to loan money was positively associated with all four individual‐level social capital variables, suggesting that availability of instrumental resources may be important to ongoing recovery. To test whether these house‐level social network factors then support recovery, a survival analysis was conducted, finding associations between relapse risk and the network densities over a 28‐month span. In particular, more dense advice‐seeking networks were associated with higher rates of relapse, suggesting that the advice‐seeking might represent a sign of organisational house problems, with many residents unsure of issues related to their recovery. In contrast, more dense loaning networks were associated with less relapse, so willingness to lend money could be measuring a willingness to help those in need. The implications of these findings are discussed.     

Not Simply in the Eye of the Beholder: Authenticity as a Product of Candidate Preference and Unfettered Speech

Authenticity has emerged over recent decades as a prominent theme in both the press and in political research—and peaked in the 2016 presidential contest that pitted Donald Trump against Hillary Clinton, Bernie Sanders, Marco Rubio, and Ted Cruz. In this context, we attempted to answer the question: How do voters judge a presidential candidate's authenticity? Here we use motivated reasoning and correspondent inference theory as theoretical frameworks to examine how partisan preference combines with perceptions of unfettered speech and strategic impression management to influence voter judgments of a candidate's authenticity. An online survey of 525 respondents demonstrated that individuals' partisan preferences influenced both judgments of a candidate's authenticity and their perceptions of behaviors signifying authenticity (use of unfettered speech versus strategic impression management). These behavioral signals partially mediated the relation between candidate preferences and authenticity judgments. Moreover, voters, given their partisan preferences, differentially weighted candidates' use of unfettered speech and strategic impression management tactics in their judgments of authenticity. Finally, unfiltered/politically incorrect speech was found to have both positive and negative effects on authenticity judgments. Findings further elucidate the nature of authenticity as perceived in others and identify intermediary variables and boundary conditions that influence those perceptions.     

Does a Positive Bias Relate to Social Behavior in Children With ADHD?

This study examines whether positively biased self-perceptions relate to social behaviors in children with attention-deficit/hyperactivity disorder (ADHD) as compared to control children. The social behaviors of children with ADHD (n = 87) were examined relative to control children (CTL; n = 38) during a laboratory-based dyadic social interaction task. Children with ADHD were subgrouped into those with a positive illusory bias (PIB) in their self-perceptions (ADHD + PIB) versus those without such a bias (ADHD – PIB). Using a behavioral coding system adapted for this study, ADHD + PIB, ADHD – PIB, and CTL participants were compared on objectively coded social behaviors occurring within the context of the social interaction task. Whereas both ADHD groups displayed more disruptive behavior than controls, only the ADHD + PIB group displayed less prosocial behavior and less effortful behavior. This study breaks new ground by examining positively biased self-perceptions as they relate to social behavior in children with ADHD and provides promising new insight into the social problems experienced by these children.     

The affective consequences of cognitive inhibition: devaluation or neutralization?

Affective evaluations of previously ignored visual stimuli are more negative than those of novel items or prior targets of attention or response. This has been taken as evidence that inhibition has negative affective consequences. But inhibition could act instead to attenuate or "neutralize" preexisting affective salience, predicting opposite effects for stimuli that were initially positive or negative in valence. We tested this hypothesis by presenting trustworthy and untrustworthy faces (Experiment 1), strongly positive and negative photographs (Experiment 2), and monetary gain- and loss-associated patterns (Experiment 3) in a Go/No-Go task and assessing subsequent affective ratings. Evaluations of prior No-Go (inhibited) stimuli were more negative than of prior Go (noninhibited) stimuli, regardless of a priori affective valence. Ratings of No-Go stimuli also became increasingly negative (vs. increasingly neutral) when preexisting salience was increased via stimulus repetition (Experiment 4). Our results suggest inhibition leads to affective devaluation, not affective neutralization.     

Anchoring the Panic Disorder Severity Scale

The Panic Disorder Severity Scale (PDSS) is a clinician-administered measure of panic disorder symptom severity widely used in clinical research. This investigation sought to provide clinically meaningful anchor points for the PDSS both in terms of clinical severity as measured by the Clinical Global Impression-Severity Scale (CGI-S) and to extend its clinical meaningfulness by examining its association with quality of life. A total of 63 individuals with a primary diagnosis of panic disorder were assessed on completion of a 6- or 8-week psychotherapy or pharmacotherapy trial for the treatment of panic disorder. As expected, the PDSS was correlated with both the CGI-S and quality of life. These results provide further support for the validity and clinical utility of the PDSS and provide simple anchors to help guide the potential use of the PDSS scale to measure treatment progress in clinical practice.     

Driver performance effects of simultaneous visual and cognitive distraction and adaptation behavior

Driver distraction has become a major concern for transportation safety due to increasing use of infotainment systems in vehicles. To reduce safety risks, it is crucial to understand how fundamental aspects of distracting activities affect driver behavior at different levels of vehicle control. This study used a simulator-based experiment to assess the effects of visual, cognitive and simultaneous distraction on operational (braking, accelerating) and tactical (maneuvering) control of vehicles. Twenty drivers participated in the study and drove in lead-car following or passing scenarios under four distraction conditions: without distraction, with visual distraction, with cognitive distraction, and with simultaneous distraction. Results revealed higher perceived workload for passing than following. Simultaneous distraction was most demanding and also resulted in the greatest steering errors among distraction conditions during both driving tasks. During passing, drivers also appeared to slow down their responses to secondary distraction tasks as workload increased. Visual distraction was associated with more off-road glances (to an in-vehicle device) and resulted in high workload. Longer headway times were also observed under visual distraction, suggesting driver adaptation to the workload. Similarly, cognitive distraction also increased driver workload but this demand did not translate into steering errors as high as for visual distraction. In general, findings indicate that tactical control of a vehicle demands more workload than operational control. Visual and cognitive distractions both increase driver workload, but they influence vehicle control and gaze behavior in different ways.     

Domestic dogs’ (Canis familiaris) choices in reference to agreement among human informants on location of food

When interacting with others, informants may offer conflicting information or information of varying accuracy. Recent research suggests that young children do not trust all informants equally and are selective in both whom they solicit for information and whose claims they support. We explored whether domestic dogs (Canis familiaris) are similarly sensitive to agreement among informants. To this end, we utilized a common human gesture, pointing, to which recent research suggests dogs are sensitive. We conducted two experiments in which an experimenter secretly hid food in one of two clear containers while the dog was distracted. Next, a small group moved to indicate the food's location using stationary points positioned above the containers. In Experiment 1, two experimenters moved to stand behind the non-baited container, while a third experimenter moved to stand behind the baited container. Then, all directed one static point at the container in front of them. Experiment 2 exactly resembled Experiment 1 with the exception that the single experimenter standing behind the baited container directed two static points at the container (one with each hand). Dogs chose the container indicated by the majority in Experiment 1 significantly more often than chance, but chose the container indicated by the minority in Experiment 2 significantly more often than chance. This suggests that the number of points, not the number of people, more strongly influenced dogs' choices.     

A Systematic Review of the Biopsychosocial–Spiritual Health of Active Duty Women

Women make up approximately 15% of today’s active duty (AD) military. Not only are more women volunteering for military service now than ever before in America’s history, but due to recent policy changes, they are also allowed to apply for more jobs. Therefore, since the number of women in the military is continuing to rise and there are more job opportunities for women in the military, it is important to understand the unique health effects they experience that differ from civilian women and AD males. Although there is current literature on the biological, psychological, social, and spiritual health of veteran women, few researchers have explored the biopsychosocial–spiritual effects of military service on AD women. Thus, the purpose of this systematic review was to explore the existing research on the biopsychosocial–spiritual health factors associated with military service in AD women. The results of this study indicated that there is more data on the biological health compared to the psychological and social health of AD women. There is even less research demonstrating the interconnectedness among biological, psychological, social, and spiritual health with AD women. Future research recommendations and policy implications are provided.