Does Adding the Dialectical Behavior Therapy Prolonged Exposure (DBT PE) Protocol for PTSD to DBT Improve Outcomes in Public Mental Health Settings? A Pilot Nonrandomized Effectiveness Trial With Benchmarking

The Dialectical Behavior Therapy Prolonged Exposure (DBT PE) protocol improves DBT’s effects on PTSD in research settings, but its effectiveness in community settings is largely unknown. This pilot nonrandomized controlled trial examined DBT with and without DBT PE in four public mental health agencies. Patients (N = 35, 12-56 years old, 80.0% female, 64.7% racial/ethnic minorities, 44.1% sexual minorities) had PTSD, were receiving DBT, and completed assessments every four months over one year. Sixteen patients (45.7%) initiated DBT PE, 19 (54.3%) did not, and dropout did not differ between groups (31.3% vs. 26.3%). The primary barrier to initiating DBT PE was clinician turnover (57.9% of non-initiators). After adjusting for confounds, DBT PE initiators (g = 1.1) and completers (g = 1.4) showed a greater reduction in PTSD than patients who received DBT only (g = 0.5; p’s < .05). Rates of reliable improvement in PTSD were 71.4% (DBT PE completers), 53.8% (DBT PE initiators), and 31.3% (DBT). Similar patterns were observed for posttraumatic cognitions, emotion dysregulation, general psychological distress, and limited activity days. There was no worsening of self-injurious behavior or crisis service use among patients who received DBT PE. Benchmarking analyses indicated comparable feasibility, acceptability, and safety, but a smaller magnitude of clinical change, than in efficacy studies. Results require replication in a randomized trial but suggest that DBT PE can be transported effectively to community settings.     

What is the Meaning of Proofs?

Journal of Philosophical Logic - The origins of proof-theoretic semantics lie in the question of what constitutes the meaning of the logical connectives and its response: the rules of inference...     

Challenges and Potential Solutions to Implementing Phone Coaching in Dialectical Behavior Therapy

Dialectical Behavioral Therapy (DBT) is an effective treatment for borderline personality disorder (BPD), yet many health care facilities struggle to implement one of the modes of DBT, phone coaching. The aims of this study were to present barriers and reported solutions regarding the implementation of DBT phone coaching. We conducted a sequential mixed methods national program evaluation that included a quantitative self-report survey completed by Department of Veterans Affairs (VA) facilities (N = 59) offering any of the four modes of DBT. Subsequent qualitative interviews using a semistructured interview guide informed by the Promoting Action on Research Implementation in Health Services (PARIHS) were completed with DBT providers and administrators from a subset (n = 16) of these VA sites. Four themes—the lack of tools and policies, compensation for phone coaching, clinician willingness to conduct phone coaching, and consistent program and leadership support—were identified and illustrated in a case study. This study also offered concrete recommendations for those health care organizations, managers, administrators, and clinicians who may be interested in implementing phone coaching at their health care facilities.     

Beyond family‐level adversities: Exploring the developmental timing of neighborhood disadvantage effects on the brain

A growing literature suggests that adversity is associated with later altered brain function, particularly within the corticolimbic system that supports emotion processing and salience detection (e.g., amygdala, prefrontal cortex [PFC]). Although neighborhood socioeconomic disadvantage has been shown to predict maladaptive behavioral outcomes, particularly for boys, most of the research linking adversity to corticolimbic function has focused on family‐level adversities. Moreover, although animal models and studies of normative brain development suggest that there may be sensitive periods during which adversity exerts stronger effects on corticolimbic development, little prospective evidence exists in humans. Using two low‐income samples of boys (n = 167; n = 77), Census‐derived neighborhood disadvantage during early childhood, but not adolescence, was uniquely associated with greater amygdala, but not PFC, reactivity to ambiguous neutral faces in adolescence and young adulthood. These associations remained after accounting for several family‐level adversities (e.g., low family income, harsh parenting), highlighting the independent and developmentally specific neural effects of the neighborhood context. Furthermore, in both samples, indicators measuring income and poverty status of neighbors were predictive of amygdala function, suggesting that neighborhood economic resources may be critical to brain development.     

Sex differences in adolescent ethanol drinking to behavioral intoxication

Rodent models have been especially useful for investigating adolescent ethanol exposure. However, there is a paucity of studies examining sex differences in behavioral intoxication from adolescent ethanol drinking. Here, we used an ethanol drinking model to investigate if adolescent rats of both sexes readily drink ethanol to measurable behavioral intoxication, indicated by increased impulsive action and motor incoordination. Beginning on postnatal day (P) 28, male and female Long‐Evans rats were given 30‐min access to a solution of sucrose (20%) or sweetened ethanol (20% sucrose +15% ethanol) every other day until P60 and once after 2 weeks of forced abstinence (on P75). On alternate (nondrinking) days, rats were reinforced with a food pellet for making a cued nosepoke response. Beginning on P56, rats were tested in this task after drinking sessions to assess ethanol‐induced changes in impulsive action, defined as premature responding prior to cue presentation. Motor coordination was assessed before and after drinking sessions using an incline plane test. Adolescent male and female rats readily consumed ethanol to behavioral intoxication, measured as reduced motor coordination. Following forced abstinence, females displayed greater ethanol‐induced impulsive action. These studies provide evidence for sex differences in behavioral intoxication following adolescent ethanol drinking.     

Alexithymia, Cumulative Feedback, and Differential Response Patterns on the Iowa Gambling Task

ABSTRACT Although the role of emotional processing is central to contemporary models of risky decision making, to date the role of trait emotional understanding has not been explored experimentally in this context. The current experiment ( N =326) explores the role of alexithymia with respect to performance on the standard Iowa Gambling Task (IGT) and a version where cumulative financial feedback is obscured. Standard learning on the IGT was observed for those low in alexithymia. Those high in alexithymia learned to avoid disadvantageous decks over the first half of the task. However, over the later trials they showed a change in performance, shifting from advantageous to disadvantageous and back to advantageous decks again (termed an "explore-learn-change-return" strategy). It is argued that this is due to an inability to fully consolidate earlier learning and reduced sensitivity to losses. The absence of cumulative feedback independently resulted in reduced performance.     

Impact of simulated visual impairment on the cognitive test performance of young adults

Aims. This study investigated the effect of simulated visual impairment on the speed and accuracy of performance on a series of commonly used cognitive tests. Methods. Cognitive performance was assessed for 30 young, visually normal subjects (M=22.0±3.1 years) using the Digit Symbol Substitution Test (DSST), Trail Making Test (TMT) A and B and the Stroop Colour Word Test under three visual conditions: normal vision and two levels of visually degrading filters (Vistech^TM) administered in a random order. Distance visual acuity and contrast sensitivity were also assessed for each filter condition. Results. The visual filters, which degraded contrast sensitivity to a greater extent than visual acuity, significantly increased the time to complete (p<.05), but not the number of errors made, on the DSST and the TMT A and B and affected only some components of the Stroop test. Conclusions. Reduced contrast sensitivity had a marked effect on the speed but not the accuracy of performance on commonly used cognitive tests, even in young individuals; the implications of these findings are discussed.     

Age effects on attentional blink performance in meditation

Here we explore whether mental training in the form of meditation can help to overcome age-related attentional decline. We compared performance on the attentional blink task between three populations: A group of long-term meditation practitioners within an older population, a control group of age-matched participants and a control group of young participants. Members of both control groups had never practiced meditation. Our results show that long-term meditation practice leads to a reduction of the attentional blink. Meditation practitioners taken from an older population showed a reduction in blink as compared to a control group taken from a younger population, whereas, the control group age-matched to the meditators’ group revealed a blink that was comparatively larger and broader. Our results support the hypothesis that meditation practice can: (i) alter the efficiency with which attentional resources are distributed and (ii) help to overcome age-related attentional deficits in the temporal domain.     

The Utility of Genetic Counseling Prior to Offering First Trimester Screening Options

In order to evaluate the utility of genetic counseling at the time of first trimester screening in patients with no previously identified genetic concerns, we reviewed family history data for 700 women seen for genetic counseling in Utah during 2005-2006. The mean maternal age was 35 years (Range: 16–47 years). The majority of patients seen were non-Jewish Caucasians (90.8%, 634/700). A three-generation pedigree was obtained from each woman by one of two certified genetic counselors and subsequently classified as “negative” (no birth defects/genetic disorders); “positive” (birth defect or genetic condition with a minimal/low risk of recurrence; additional evaluation/genetic testing during pregnancy not indicated); or “significant” (birth defect or genetic condition with an increased risk of recurrence; additional evaluation/genetic testing during the pregnancy indicated). About 72% (501/700) of the histories were negative, 19% (134/700) were positive, and about 9% (65/700) were significant. Among patients with significant family histories, 66% (n = 43) were women less than 35 years of age. We conclude that assessing a patient’s family history at the time of first trimester serum screening is a valuable resource for pregnancy management.