Using Multiple Contexts and Retrieval Cues in Exposure-Based Therapy to Prevent Relapse in Anxiety Disorders

The benefits of exposure-based interventions for anxiety disorders are substantial but not stable for everyone, given that these interventions are often followed by relapse of symptoms. A body of research provides a background on how to add certain strategies in exposure-based therapy to prevent relapse in anxiety disorders. This review summarizes some of these strategies and provides clear-cut clinical implications. Studies that provide support for two types of strategies to prevent relapse have been reviewed—the use of multiple contexts and the use of retrieval cues. The use of multiple contexts reduces context and stimulus specificity of extinction learning during exposure, while the use of retrieval cues enhances memory (re)consolidation and retrieval after exposure. The described strategies to enhance the accessibility and therefore the retrievability of exposure-based learning to prevent relapse in anxiety disorders can be summarized as advice to conduct exposure under variable conditions. This way, the generalizability of what is learned during exposure to the patients’ daily life after treatment improves. Therefore, adding these strategies in the course of exposure-based treatment of anxiety disorders seems beneficial. However, future replications and translational studies are needed to verify ecological validity.     

Do Marital Conflict Behaviors in Response to a Novel Stressor Uniquely Predict Adolescent Outcomes?

The goal of this study was to examine whether mothers’ and fathers’ marital conflict behaviors in response to a novel stressor are uniquely predictive of adolescent outcomes. Previous research establishing the detrimental consequences of marital conflict for child outcomes has relied exclusively on assessments of conflict that measure reoccurring or past conflict. From 153 adolescents and/or both of their parents, reports were gathered on marital conflict, adolescent conflict appraisals, parent-adolescent relationship quality, and adolescent adjustment. Couples engaged in two marital problem-solving interaction tasks—one that elicited conflict behaviors by requiring discussion of salient, reoccurring topics of disagreement and one that prompted conflict behaviors by requiring that couples worked together to solve an unfamiliar problem. Results indicated that compared to behaviors during the marital conflict discussion as well as parent-reports of the frequency, intensity, and resolution of typical conflict, conflict behaviors in response to a novel stressor, particularly those displayed by mothers, were uniquely associated with adolescents’ conflict appraisals and dimensions of the parent-adolescent relationship but not adolescent adjustment. Specifically more-negative (relative to positive) conflict behaviors in response to the novel stressor was associated with more-negative adolescent conflict appraisals; mothers’ more-negative conflict behaviors in response to a novel stressor were also linked to adolescents reporting less parental monitoring. In contrast, parent reports of typical marital conflict uniquely predicted conflict property appraisals, the affective quality of mother-adolescent relationships, and adolescent adjustment. Implications for future research elucidating associations between conflict behaviors in response to a novel stressor on children and families are discussed.     

Promoting Mental Health Equity: The Role of Integrated Care

People suffering from mental illness experience poor physical health outcomes, including an average life expectancy of 25 years less than the rest of the population. Stigma is a frequent barrier to accessing behavioral health services. Health equity refers to the opportunity for all people to experience optimal health; the social determinants of health can enable or impede health equity. Recommendations from the U.S. government and the World Health Organization support mental health promotion while recognizing barriers that preclude health equity. The United States Preventive Services Task Force recently recommended screening all adults for depression. The Satcher Health Leadership Institute at the Morehouse School of Medicine (SHLI/MSM) is committed to developing leaders who will help to reduce health disparities as the nation moves toward health equity. The SHLI/MSM Integrated Care Leadership Program (ICLP) provides clinical and administrative healthcare professionals with knowledge and training to develop culturally-sensitive integrated care practices. Integrating behavioral health and primary care improves quality of life and lowers health system costs.     

Appraisals of Interparental Conflict and Change in Attention to Emotion after Exposure to Marital Conflict

The goal of this study was to investigate whether exposure to marital conflict changes patterns of attention to anger and happiness, as well as whether those patterns vary based on appraisals of the history of interparental conflict in the home. Emerging adults viewed photo pairs with one emotionally-neutral photo and another photo depicting a happy/angry emotional interaction (while a high-speed camera tracked gaze), were randomly assigned to view a neutral or marital conflict recording, viewed neutral-emotional photo pairs again, and then reported their appraisals of their parents’ conflict. Results indicated that feeling threatened by and to blame for parental conflict predicted avoidance of happy emotions at baseline. Although there were no significant changes in attention to emotion overall based on condition, self-blame for interparental conflict predicted greater increases in time spent looking at anger after watching marital conflict (but not after watching the neutral recording). These results indicate that differences in attention to emotion may be one mechanism linking parental conflict to anxiety that could be the focus of prevention/intervention efforts to reduce anxiety symptoms in those from high-conflict homes.     

An evaluation of a caregiver training protocol on the generalization and maintenance of successful pediatric feeding interventions

Previous researchers have documented the positive effects achieved by trained clinicians providing behavioral interventions for pediatric feeding disorders; however, few have evaluated the maintenance of those treatments when subsequently implemented by primary caregivers. Further, the majority of previous caregiver training research has relied on the use of multicomponent training packages making it difficult to determine which components are necessary for success. The purpose of the current investigation was to evaluate the effects of instructions and feedback on caregivers' implementation of feeding protocols in a home setting. Results of the current study suggest that feedback may be the most effective training component in training packages designed to teach caregivers to implement an effective feeding protocol. Potential concomitant changes in child behavior are also discussed.     

Where’s the problem? Considering Laing and Esterson’s account of schizophrenia,social models of disability,and extended mental disorder

In this article, I compare and evaluate R. D. Laing and A. Esterson’s account of schizophrenia as developed in Sanity, Madness and the Family (1964), social models of disability, and accounts of extended mental disorder. These accounts claim that some putative disorders (schizophrenia, disability, certain mental disorders) should not be thought of as reflecting biological or psychological dysfunction within the afflicted individual, but instead as external problems (to be located in the family, or in the material and social environment). In this article, I consider the grounds on which such claims might be supported. I argue that problems should not be located within an individual putative patient in cases where there is some acceptable test environment in which there is no problem. A number of cases where such an argument can show that there is no internal disorder are discussed. I argue, however, that Laing and Esterson’s argument—that schizophrenia is not within diagnosed patients—does not work. The problem with their argument is that they fail to show that the diagnosed women in their study function adequately in any environment.     

‘We’ve shared a lifetime with one another’: using reflective visual/verbal journals to develop graduate student relationships

The success of graduate students relies on factors beyond mere cognitive ability, with fostering peer and professional relationships as definitive influences on achievement. Research shows that positive faculty/student relationships are a significant factor in the success of graduate students and that art-making is an effective way to encourage the reflective thinking needed to nurture these relationships. In this article, we examine the relationship between arts informed pedagogy, specifically the use of a visual/verbal journal, and the formation of graduate relationships. The majority of the students in this collaborative inquiry entered their doctoral program at the same time the research class began and all engaged in an artfully imagined introduction to qualitative research course.     

So Why Do You Think That Way?: Examining the Role Implicit Attitudes and Motivation Play in Audience’s Perception of a Racially Charged Issue

Events in Ferguson (MO), the Eric Garner incident, and most recently Chicago (IL), have again brought perceptions of race to the forefront of the public’s conscience. Often perceptions of racially charged events are split along racial lines with Whites often siding with law enforcement and Blacks seeing a miscarriage of justice. Bifurcated perceptions along racial lines are nothing new, dating back to the early 1900s. Despite this schism, few analyses have examined the genesis of this difference in perceptions on racial issues. This analysis looks to fill that gap. Specifically, we examine the role media frames and people’s preexisting attitudes and motivations play in determining what they think of contentious race issues and the people involved in them. Using the Jena Six incident as a case study, we find that people with less egalitarian racial attitudes—and low motivation to hide those attitudes—are less likely to blame race-related problems on mitigating cultural factors. They are also more likely judge news stories about a racial issue as being low quality. However, thematically framed stories that include discussion of the cultural aspects of the event may help to reduce this process.     

Facial gender confirmation surgery—review of the literature and recommendations for Version 8 of the WPATH Standards of Care

Facial gender confirmation surgery (FGCS), also popularly known and referred to in the scientific literature as facial feminization surgery (FFS), was previously treated as a collection of aesthetic procedures complementing other aspects of gender-confirming surgery. Recent literature on quality-of-life outcomes following FGCS has supported the substantial impact these procedures have on overall well-being and reduction of psychosocial sequelae in patients. The World Professional Association for Transgender Health Standards of Care, Version 7 (WPATH SOC 7), did not deem FGCS a medical necessity. Based on these new studies, increasing evidence points to the need to include FGCS among medically necessary gender-confirming surgeries, though more-prospective studies are needed. Updates to the WPATH SOC 8 are proposed based on available quality of life studies.