Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl

The alpha-2 adrenergic receptor antagonist, yohimbine, can facilitate fear extinction in animals and humans. One potential mechanism is increased noradrenergic activity and associated arousal in the presence of conditioned stimuli. Accordingly, yohimbine might augment prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD), where heightened exposure-oriented arousal is a theorized driver and empirical predictor of treatment success. A double-blind placebo-controlled randomized trial (NCT 01031979) piloted yohimbine augmentation in 26 males with combat-related PTSD. Participants were given one-time dose of yohimbine or placebo prior to the first imaginal exposure. Subsequently, both arms completed standard PE. The primary outcome was trauma-cued heart-rate reactivity a week after the drug/exposure visit, a highly specified, objective measure sensitive to incremental change. Secondary outcomes included arousal during the drug/exposure visit and slope of distress, PTSD, and depression over the course of PE. Consistent with hypothesis, yohimbine led to higher objective and subjective arousal during the drug/exposure visit and to lower trauma-cued heart-rate reactivity one-week later. One dose of yohimbine also led to greater between-session habituation and more rapid improvement on depression, but not PTSD, over the course of care. Results of this controlled pilot indicate support for continued investigation of yohimbine-augmented exposure therapy for PTSD.     

Detecting Clusters/Communities in Social Networks

Cohen's κ, a similarity measure for categorical data, has since been applied to problems in the data mining field such as cluster analysis and network link prediction. In this paper, a new application is examined: community detection in networks. A new algorithm is proposed that uses Cohen's κ as a similarity measure for each pair of nodes; subsequently, the κ values are then clustered to detect the communities. This paper defines and tests this method on a variety of simulated and real networks. The results are compared with those from eight other community detection algorithms. Results show this new algorithm is consistently among the top performers in classifying data points both on simulated and real networks. Additionally, this is one of the broadest comparative simulations for comparing community detection algorithms to date.     

Similes on the Internet have explanations

We searched the Internet for expressions linking topics, such as crime, and vehicles, such as disease, as similes (crime is like a disease) and as metaphors (crime is a disease). We counted the number of times the expressions were accompanied by explanations (crime is like a disease because it spreads by direct personal influence). Similes were more likely than metaphors to be accompanied by explanations. Similes may be preferred if a writer wants to express an out-of-the-ordinary relation between the topic and the vehicle.     

Chimpanzees (Pan troglodytes) remember the location of a hidden food item after altering their orientation to a spatial array

Two chimpanzees (Pan troglodytes) had a direct view of an experimenter placing a food item beneath one of several cups within a horizontal spatial array. The chimpanzees then were required to move around the spatial array, shifting their orientation to the array by 180 degrees . Both chimpanzees remembered the location of the food item. In the next experiment, a visual barrier was placed between the chimpanzees and the spatial array after the food item had been hidden to prevent visual tracking of the location of the object during the chimpanzees' movement. One chimpanzee remembered the location of the hidden item in this variation. These results demonstrate another capacity for spatial memory in this species that complements data indicating chimpanzee spatial memory for invisible displacements, array rotations, and array transpositions.     

A New Methodology for Reporting the Status of Community Health Improvement in the United States

Objective To assure that Healthy Communities are achieved, a tracking methodology is proposed using four health improvement categories. Methods Counties are classified as having met or not met nine HP2010 mortality targets and as improving or not improving, creating four categories of community health improvement – static, progressing, exemplary, and maintaining. Results Exemplary counties make up 1.7%32.7% of counties, counties have both improved and met the HP2010 target during the period. Across all indicators, a large proportion remains of counties that have neither met the HP2010 target nor improved (33.572.8%). Conclusions Understanding why, how, and in what ways communities move from static to maintaining categories is necessary to guiding every local public health system to community health improvement.     

Confidant Relations Among Taiwanese: Implications for Ethnic Chinese Health Care Treatment

The select individual(s) whom one trusts in sharing important personal matters is sometimes referred to as a confidant. The confidant relationship has received increasing attention in recent years as a major social factor contributing to individual health and wellness. Yet, little empirical data has been available to guide health researchers, policy-makers, and practitioners. In this study, 142 adult Taiwanese responded to a structured questionnaire. Participants comprised 105 females, 32 males, and five with sex unspecified (overall mean age?=?33.8, age range?=?18 to 74 years). They were asked whether they had a confidant, and if so, to describe various features of this relationship. Contrary to previous studies conducted in Europe and the Americas, our investigation found that Taiwanese men were equally likely as Taiwanese women to have a confidant (87.5 % of males and 89.5 % for females). Taiwanese women were significantly more likely to have a female rather than a male confidant, whereas males showed no such sex difference. A significantly higher percentage of confidants were non-family members rather than spouses or other immediate/extended family members. This finding is consistent with research on the relatively minor salience of emotional intimacy in Taiwanese marriages and the hierarchical structures of many Taiwanese families. The implications of our findings for enhancing Taiwanese and broader ethnic Chinese health treatment are discussed.     

Discussion: Toward a social‐constructivist view of the psychoanalytic situation

The three papers by Modell, Aron, and Greenberg are discussed in terms of their relationship to a new paradigm for understanding the psychoanalytic situation. The paradigm is called social‐construct‐ivist to capture both the idea of the analyst's participation and the idea of construction of meaning. It is argued that these theorists, as well as many of the authors they cite as part of a broad movement in the field, do not consistently meet the criteria for this paradigm, although they seem to be aiming for it. An important source of inconsistency and confusion derives from the confounding of the two axes: drive‐relational and positivist‐constructivist. Many relational theorists who hold fast to the idea that analysts can grasp the truth of both their own experience and that of the patient are no closer to the constructivist point of view than was Freud. The call by Aron and Greenberg for greater attention to the patient's resisted experience of the analyst's subjectivity is discussed in terms of its potential benefits and problems. The ritualized asymmetry of the psychoanalytic situation is said to have important functions, including prevention of excessive involvement and protection of the unobjectionable positive transference and of a degree of idealization. Modell's notion of paradox, which makes the therapeutic relationship seem “real”; and “unreal”; at the same time, is seen as a special instance of the always precarious social construction of reality. It is argued, moreover, that the social and individual aspects of experience are interdependent. Neither is reducible to the other, and both should be understood, like many other issues in the new paradigm, in terms of a dialectical interplay of figure and ground in experience.     

Response to Slavin: Considering the Evolutionary and Existential Contexts of Dialectical Constructivism

Within his evolutionary framework, Slavin elaborates eloquently on the dialectic of construction of meaning and anticipation of death. Also within that framework he highlights the emergence of the universal dialectic of self-interest and care for others, perhaps finding its most poignant expression in the relation of parents and children. I raise questions about Slavin's attribution of a “sense of loss” to humans who allegedly long for the experience of evolutionarily earlier species, particularly their sense of automatic connectedness and automatic ways of relating to the world free of the burdens of uncertain, self-conscious choice. A longing for earlier states in human development is easier to grasp than a longing for the experience of less advanced species from which humans evolved. Nevertheless, Slavin's views and my own are otherwise deeply compatible, particularly his sense of what emerges as the uniquely human challenge of intersubjective construction of meaning in the context of individual self-interest and in the face of death. Slavin is also emphatic that the pervasiveness of absolute belief systems that preempt awareness of ambiguity, the anxiety of freedom, and the dread of death, does not gainsay their defensive nature. I argue, in accord with Altman, Butler, and others, that denial of death may promote dissipation of communal sensibility and replacement of it in a capitalist world (and perhaps others as well) with destructive splitting and fetishistic, competitive pursuit of money and power.     

Response to Safran: The Development of Critical Psychoanalytic Sensibility

Jeremy D. Safran feels that my views regarding the relative merits of case studies and systematic empirical research are unnecessarily polarizing. I feel that, on the contrary, I'm offering bridges between my perspective and those of researchers on psychoanalytic process and outcome in two ways. One is through my own constructivist critique of traditional positivist case studies and theorizing based upon clinical experience. The second is through conceptualizing the place of systematic research within a constructivist paradigm. I am arguing that its place can be no different than that of case studies. Both generate possibilities for any particular analyst or analytic therapist to have in mind as he or she works with a particular patient at a particular moment. Safran locates the destructive effects of scientism with “biologically oriented researchers and cognitive therapists.” In my view, it might be convenient if the problem could be located exclusively with them, but the fact is that psychoanalytic researchers, as I demonstrate, are working largely within the same paradigm as their adversaries in the research world. That paradigm erroneously privileges systematic research as hypothesis-testing, whereas case studies are relegated to the status of anecdotal, hypothesis-generating work. I describe what I call “nonlinear constructivist learning” as the kind of “generalization” that case studies can yield and that is optimal for our field.     

Attentional and behavioural responses of spider fearfuls to virtual spiders

This study employed an immersed virtual environment (IVE) in the Nijmegen RIVERlab to study spider fearfuls’ attentional and motor reactions to virtual spiders. The participants were exposed to virtual spiders while completing an unrelated task, walking freely through a virtual museum. Compared to non-fearful controls, spider fearfuls showed an increase in state anxiety, they spent more time looking at spiders, and they exhibited spontaneous behavioural avoidance of spiders and visually similar objects. The results extend, and to some degree contradict, those of earlier studies with static pictures, and they speak to the usefulness of state-of-the-art IVEs in fundamental anxiety research.