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.     

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.     

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.     

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.     

Foundations of the human sciences 1 : Beyond reductionism: The emerging holistic paradigm in education

Abstract

Modern educational theory and practice are grounded in an objec‐tivistic, reductionistic world view, particularly a “natural science” conception of human development. Holistic education is a radically non‐reductionistic approach based upon a person‐centered, ecological, global and spiritual world view. As such, the holistic paradigm is an alternative not only to the scientistic reductionism of the modern age, but also to the intellectual reductionism of postmodern thought. Holistic education is a humanistic as well as spiritual critique of the dominant culture.     

Psyche and Cinema: “Go Ask Alice (or Neo); I Think They'll Know”

The Walt Disney version of Alice in Wonderland is a musical animation beginning in a semi-pastoral setting with butterflies, birds, and daisies. Alice is bored with the textual reading of classical history being given by her uptight Victorian sister. Instead, she wants images, pictures in a book. She sees image as world. “In my world, books will have nothing but pictures,” she declares. This thought takes her further into her imagination and the deconstructive realm it creates. “Everything will be what it isn't and not be what it is.” Finally, she looks into a pond and the reflection of a white rabbit dressed in a frock coat passes by. The mirror of the water surface has released an image of the “other,” an animal, difficult to catch and associated with luck, fertility, and the underground. Alice follows the rabbit into a hole and takes a fall, a radical descent into the underworld. She speculates about descending through the earth to the other side and walking around upside down. She finally lands in front of a door with a punning knob that takes three linguistic “turns.” For Alice, it is impassible but not impossible. Stuck and distraught, she finally gets caught up in the flow of her tears, and rides through the door on her stream of consciousness.     

The lived experiences of people diagnosed with multiple sclerosis in relation to exercise

The purpose of this study was to examine the lived experiences of people diagnosed with Multiple Sclerosis (MS). Seven active exercisers with MS participated in semi-structured interviews regarding their exercise experiences since diagnosis. Data were analysed using Interpretative Phenomenological Analysis (IPA; Smith?&?Osborn, 2003 Smith, JA and Osborn, M. 2003. “Interpretive phenomenological analysis”. In Qualitative psychology: A practical guide to research methods, Edited by: Smith, JA. 51–80. London: Sage.  [Google Scholar]). Interpretive Phenomenological Analysis. The results and interpretations of narratives revealed a number of functional limitations due to the severity of MS symptoms, which were found to have a major effect on the ability of the participants to exercise. Furthermore, psychological problems and the heightened behavioural adjustments to the progressive disability led to re-appraisal of ability to exercise. Previous, relevant exercise experience made participants more determined to continue to be able to exercise after diagnosis. The wider exercise experience narratives were related to concerns about safety, dependability on others to overcome the challenges, and potential environmental hazards. The loss of spontaneous opportunities to exercise because of these actual and perceived barriers was key to this population. This research highlighted the need to rethink the health and social service arrangements in relation to exercise provision for individuals with MS.     

Two sides of the same coin? On the history and phenomenology of chronic fatigue and burnout

Background: Burnout and chronic fatigue syndrome (CFS) are two fatigue syndromes which have developed largely independently from each other, yet whose similarities in symptoms can be a source of confusion. We aim to explore the phenomenology of burnout and CFS in a historical context as this may provide some insight into the links and relationship between these conditions. Method: A narrative review based on literature in the fields of history, social science and medicine. Results: The origins of CFS lie within medicine, whereas burnout developed in a psychological setting. As well as symptoms, burnout and CFS also share similar themes such as an overload process triggering illness onset, the need for restoration of depleted energy, external causal attributions and the characteristics of people suffering from these illnesses. However, these themes are expressed in either psychological or medical terms according to the historical background. Conclusion: Despite their similarities, there have been few direct comparisons of the two concepts. Culture, illness perceptions and accountability are important issues in both conditions and could contribute to their differences. Comparing burnout and CFS within one sample frame, thus looking beyond the psychology/medicine divide, could be a useful first step towards understanding their relationship.     

Rehabilitative Beit Midrash as a means for advancing the community integration of Ultra Orthodox Jewish persons with severe mental illness

ABSTRACT

Religious Jews with severe mental illness often encounter barriers to involvement in religious activities in their community affecting their ability to become integrated into their community. Therefore, a study was conducted in Israel examining the contribution to community integration through a programme providing religious persons with mental illness an opportunity to participate in religious studies. An A-B research design was implemented among 42 Ultra-Orthodox Jewish persons with severe mental illness utilising a culturally-oriented structured instrument. The study showed that the opportunity for involvement in religious studies could advance the participants’ sense of social interaction in their community as well as their sense of psychological integration with other religious people. It also strengthened their confidence in their ability to further get involved in religious studies in the community. Rehabilitation services providing persons with severe mental illness an opportunity for involvement in religious studies can act as a springboard for advancing their community integration.     

From implicit skills to explicit knowledge: a bottom-up model of skill learning

This paper presents a skill learning model CLARION. Different from existing models of mostly high-level skill learning that use a top-down approach (that is, turning declarative knowledge into procedural knowledge through practice), we adopt a bottom-up approach toward low-level skill learning, where procedural knowledge develops first and declarative knowledge develops later. Our model is formed by integrating connectionist, reinforcement, and symbolic learning methods to perform on-line reactive learning. It adopts a two-level dual-representation framework (Sun, 1995), with a combination of localist and distributed representation. We compare the model with human data in a minefield navigation task, demonstrating some match between the model and human data in several respects.