Anticipatory Anxiety in the Treatment of Combat Veterans with Posttraumatic Stress Disorder

Combat veterans have experienced a transformational process during war zone deployment, including emotional, cognitive, and sensory processing changes. They also return entrenched in military expectations of conduct and behavior. These changes result in anticipatory anxiety that makes it difficult to reintegrate into the civilian world, and are related to symptoms of posttraumatic stress disorder (PTSD). The PTSD Recovery Program at the McGuire Veterans Affairs Medical Center (VAMC) is a manualized treatment that focuses on the personal and daily experiences of combat veterans rather than exposure to traumatic memories. Program evaluation data demonstrated significant reduction in PTSD symptoms and improvements in general self-efficacy and adaptive behaviors. Results support the PTSD Recovery Program as an effective treatment that enhances readjustment to civilian life.     

An Intriguing Third Way: Mapping Contextual Education for Curricular Integration

This article emerges from the experience of incorporating doctoral students into our Contextual Education (CXE) Program at Emmanuel College (Toronto). This change, I argue, helped us to distinguish more clearly among and thus distinctly orient the different kinds of relationships and theological practices that make up our program towards the often‐elusive goal of curricular integration. After outlining a definition of integration, I contextualize that definition in our particular practices at Emmanuel College using Kathryn Tanner's (1997) understanding of theology as a cultural practice as my guide. I then offer a brief overview of our CXE Programs to demonstrate how nurturing strategic partnerships within them has made certain forms of integration possible for our students. I close with some activities for practical application in other CXE contexts.     

How I Attend—Not How Well Do I Attend: Rethinking Developmental Frameworks of Attention and Cognition in Autism Spectrum Disorder and Typical Development

Evidence from the study of attention among persons with autism spectrum disorder (ASD) and typically developing (TD) children suggests a rethinking of the notion that performance inherently reflects disability, ability, or capacity in favor of a more nuanced story that involves an emphasis on styles and biases that reflect real-world attending. We provide examples from behavioral and physiological research in which performance on attention tasks is not solely a function of abilities, or disabilities, per se but rather is also a function of the ways in which they are implemented. Thus, the study of attention both among persons with ASD and in typical development might best be recast in terms of the question of “how” rather than “how well.”     

Confronting the Hidden Curriculum: A Four-Year Integrated Course in Ethics and Professionalism Grounded in Virtue Ethics

Journal of Medical Humanities - We describe a virtue ethics approach and its application in a four-year, integrated, longitudinal, and required undergraduate medical education course that attempts...     

Olfactory Reference Syndrome: A Case Report and Screening Tool

Journal of Clinical Psychology in Medical Settings - Olfactory reference syndrome (ORS) is a lesser known disorder that is related to obsessive–compulsive disorder. ORS is the obsessional and...     

Habituation or Normalization? Experiential and Respiratory Recovery From Voluntary Hyperventilation in Treated Versus Untreated Patients With Panic Disorder

Psychophysiological theories postulate respiratory dysregulation as a mechanism contributing to panic disorder (PD). Additionally, symptomatic and respiratory recovery from voluntary hyperventilation (HVT-recovery) have been shown to lag in PD and it is unclear if HVT-recovery normalizes with treatment. Thirty-seven panic disorder patients were randomized to hypoventilation therapy (TX, n = 20) or waitlist control (WL, n = 17) (Meuret et al., 2008). In a secondary analysis, their HVT-recovery was analyzed at pre- and post-TX/WL, compared to 29 healthy controls (HC). HVT included three phases: 5-min baseline, 3-min hyperventilation, and 8-min recovery. HVT-elicited symptom severity and anxiety were rated following each phase, and end-tidal PCO₂ and respiratory rate (RR) were recorded throughout. Treatment, compared to WL, was highly effective in reducing PD pathology (d = 2.21, Meuret et al., 2008). At pre-TX/WL, PD demonstrated delayed HVT-recovery PCO₂ and higher RR. Treated patients demonstrated normalization of HVT-recovery for PCO₂ and RR; however, improvements of HVT-recovery for symptom severity and anxiety did not differ between TX and WL. Results replicate pretreatment HVT respiratory recovery abnormalities in PD and further demonstrate normalization, comparable to HC, following successful treatment. The results provide support for respiratory dysregulation as a feature of PD and demonstrate the utility of HVT respiratory recovery as treatment outcome measure for respiration-based PD therapy.     

Pilot Trial of Acceptance-Based Behavioral Weight Loss and Neurocognition Among American Indians

Acceptance-based behavioral therapies (ABTs) for obesity may be superior to standard behavioral therapies but have not been adequately tested with American Indians (AIs). Neurocognitive function is also unexamined in relation to behavioral weight loss among AIs despite findings that neurocognition predicts outcomes in general samples, may help explain some of the benefits of ABTs, and may be relevant to marginalized groups. The primary objective of this pilot was to examine the feasibility/acceptability of ABT in an AI sample. Exploratory analyses examined the relationship between neurocognition and weight loss. Forty-eight AI adults with overweight/obesity (ages 43.3 ± 10.3 years, 85% female; baseline body mass index = 36.8 ± 4.4 kg/m²) enrolled in a 6-month open ABT weight loss trial. Feasibility indices, including screening/enrollment, session attendance, retention rates for posttreatment assessments, and program acceptability were examined. Percent weight loss (%WL) was assessed as well as fluid and crystalized neurocognition (National Institutes of Health Toolbox Cognition Battery [NIHTB-CB]). We enrolled 79% of the eligible sample and retained 75% (N = 36) at posttreatment assessments. Program completers lost an average of 5.2 ± 4.9% of initial body weight (d_z = 1.14), whereas intent-to-treat analyses show a mean loss of 4.1 ± 4.7%. Participants reported high satisfaction, effectiveness, and cultural appropriateness. Exploratory analyses of neurocognitive domains suggested that crystalized cognition was higher among completers, and higher baseline cognitive flexibility predicted greater %WL (β = .34, p = .05). ABT resulted in clinically significant weight loss in an AI sample. A controlled trial of ABT in a larger, more diverse sample is warranted to determine whether (a) the findings are robust, generalizable, and/or superior to other treatments and (b) neurocognitive factors moderate outcomes.     

Birthweight predicts individual differences in adult face recognition ability

It has long been known that premature birth and/or low birthweight can lead to general difficulties in cognitive and emotional functioning throughout childhood. However, the influence of these factors on more specific processes has seldom been addressed, despite their potential to account for wide individual differences in performance that often appear innate. Here, we examined the influence of gestation and birthweight on adults’ face perception and face memory skills. Performance on both sub-processes was predicted by birthweight and birthweight-for-gestation, but not gestation alone. Evidence was also found for the domain-specificity of these effects: No perinatal measure correlated with performance on object perception or memory tasks, but they were related to the size of the face inversion effect on the perceptual test. This evidence indicates a novel, very early influence on individual differences in face recognition ability, which persists into adulthood, influences face-processing strategy itself, and may be domain-specific.     

Antisocial Process Screening Device Subscales Predict Recidivism in an Australian Juvenile Offender Sample

The present study is the first to examine the psychometric properties of the self-report Antisocial Process Screening Device (APSD-SR), and the predictive utility of its subscales for reoffending, among Australian juvenile offenders (N?= 308, M age = 17.00, SD?=?1.49). Exploratory factor analysis supported a modified three-factor structure in which four items loaded differently to prior studies. Total APSD-SR and modified subscale scores were positively associated with criminal history and mental health problems (e.g., internalizing and externalizing problems, alcohol and substance abuse/dependence). Survival analyses indicated that youth scoring high on the APSD-SR total score were faster to reoffend nonviolently (Hazard Ratio [HR]?= 1.31, p?=?.0003) and violently (HR?=?1.42, p?=?.0003) than those scoring low. Whereas the modified grandiose-manipulative subscale predicted faster time to nonviolent recidivism (HR?=?1.18, p?=?.026) as a single predictor, when all subscales were simultaneously entered into the model only callous-unemotional (CU) traits and impulsivity predicted nonviolent recidivism (HR?=?1.19, p?=?.026 and 1.22, p?=?.015, respectively), and only impulsivity predicted violent recidivism (HR?=?1.26, p?=?.014). Findings inform current understanding of the relative contribution of adolescent psychopathy dimensions to designating a particularly high-risk group of Australian youth in custody.