Does Exposure and Response Prevention Behaviorally Activate Patients With Obsessive-Compulsive Disorder? A Preliminary Test

Exposure and response prevention (ERP) and behavioral activation (BA) are effective treatments for obsessive-compulsive disorder (OCD) and depression, respectively. Patients with OCD often exhibit depression; furthermore, ERP for OCD is associated with reduced depressive symptoms. To our knowledge, no study has examined whether ERP itself functions to behaviorally activate patients with concurrent OCD and depressive symptoms. This prospective study was designed to test the hypotheses that (a) OCD exposure hierarchy completion, increased BA, and depressive symptom reduction would all be related, and (b) pre- to posttreatment changes in BA would mediate the direct effect of OCD hierarchy completion on posttreatment depressive symptoms, even after controlling for pretreatment depressive symptoms, pretreatment BA, pre- to posttreatment reductions in OCD symptoms, treatment duration, and antidepressant medication use. Patients (N = 90) with a primary diagnosis of OCD who received residential ERP for OCD completed a self-report battery at pre- and posttreatment. Exposure hierarchy completion, increases in BA, and decreases in depression were all significantly correlated (rs ranged .33 to .44). The effect of hierarchy completion on posttreatment depressive symptoms was fully mediated by pre- to posttreatment changes in BA. Findings highlight the potential for ERP to exert antidepressant effects by behaviorally activating patients. Limitations, clinical implications, and future directions are discussed.     

Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder?

Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the context of obsessive-compulsive disorder (OCD) treatment are mixed. The present study investigated the relationship between sudden gains and treatment outcome in 44 adults with OCD and addressed limitations of previous studies by measuring OCD symptoms dimensionally and comparing individuals who experience sudden gains to those who experience gradual gains of similar magnitude. Sudden gains were observed among 27% of participants, with highest rates among individuals with primary contamination symptoms. Participants who experienced a sudden gain had greater OCD symptom reductions at posttreatment (but not at follow-up), and this difference did not persist after controlling for gain magnitude. Thus, the importance of sudden gains during OCD treatment may be limited. Findings are discussed in light of inhibitory learning models of cognitive-behavioral therapy.     

Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment

Mental health systems need scalable solutions that can reduce the efficacy–effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high-quality care are providers’ fidelity to evidence-based treatment models and children’s and caregivers’ engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of trauma-focused cognitive-behavioral therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed-method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.     

Evidence‐Based Human Trafficking Policy: Opportunities to Invest in Trauma‐Informed Strategies

Human trafficking is a critical social issue characterized by chronic trauma among victims, and frequently preceded by traumatic experiences that contribute to risk of victimization. Therefore, the research‐based practice of trauma‐informed care is a highly appropriate lens for both prevention and intervention. This work examines federal legislation in the United States related to human trafficking for references to trauma, as well as how the use of research could implicitly direct public policy responses toward trauma‐informed approaches. Legislation on human trafficking has risen substantially since 1989, and the use of research and trauma language within these policies has also observed substantial increases. While the use of trauma language was associated with limited progression in the policy process, legislation using research language was more likely to pass out of Committee and become enacted. Moreover, legislation may leverage research in ways that have the potential to bolster trauma‐informed practice among human trafficking victims. Specifically, research can be used to describe the problem and causal mechanisms (e.g., impact of trauma), guide “best practice” for service delivery, and generate knowledge through studies and evaluations that guide future policy. Therefore, human trafficking legislation that implicitly guides trauma‐informed practice via the use of research may be particularly promising for the field.     

Man Talk: Exploring Sexual Communication Between Fathers and Sons in a Minority South African Community

Sex Roles - Much of what is known about father-child sexual communication is based on studies conducted in North America and more research into under-represented groups is needed. Our exploratory...     

Exploring the utility of functional analysis methodology to assess and treat problematic verbal behavior in persons with acquired brain injury

Functional analyses were conducted on four adults with acquired brain injuries who regularly displayed instances of inappropriate verbal behavior including depressive, aggressive, suicidal, profane, and sexually inappropriate utterances. After the functional analysis yielded a maintaining variable for each participant, a function‐based intervention consisting of differential reinforcement of alternative verbal behavior was implemented. Results of the behavioral interventions show that instances of vocal behavior can be assessed and subsequently treated using the functional analysis methodology often reserved for nonverbal forms of behavior. The utility of functional analysis for assessing complex human behavior is discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

Participant Retention in the Parents Matter! Program: Strategies and Outcome

We present a discussion of the literature addressing retention of ethnic minority samples in longitudinal studies. In addition, we describe the retention procedures implemented in the Parents Matter! Program (PMP), a community-based sexual risk reduction intervention for African American families. Finally, the results of PMP's retention strategies are presented.     

Alternative response training with contingent practice as intervention for pica in a school setting

Pica is a serious challenging behavior displayed by some persons with developmental disabilities. We report the near‐elimination of automatically reinforced pica in a 7‐year‐old boy diagnosed with autism by having him practice an alternative response (discarding objects) contingent on attempted or actual pica. Intervention was implemented 6 hours per day, under naturalistic conditions in a school setting, with outcome maintained through a 4 month follow‐up phase of evaluation. Copyright © 2003 John Wiley & Sons, Ltd.     

The Hearts and Guts of White People

Beginning with the experience of a white woman's stomach seizing up in fear of a black man, this essay examines some of the ethical and epistemological issues connected to white ignorance. In conversation with Charles Mills on the epistemology of ignorance, I argue that white ignorance primarily operates physiologically, not cognitively. Drawing critically from psychology, neurocardiology, and other medical sciences, I examine some of the biological effects of racism on white people's stomachs and hearts. I argue for a nonideal medical theory focused on improving wellness in a society that systematically has damaged the health of people of color. The essay concludes that to be fully successful, critical philosophy of race must examine not just the financial, legal, political, and other forms of racism, but also its biological and physiological operations.     

Ethnography and Subjectivity in Comparative Religious Ethics

The ethnographic turn in religious studies has responded to important developments, such as the rejection of value neutrality and the need to better address the lived experience of individuals and communities. In this essay, I affirm the value of ethnography as a method in comparative religious ethics, but distinguish between two ways of framing ethnography in relation to ethics. The first way insists on the hard limits of translating values across cultures, and tends to marginalize or dismiss normative inquiry. The second way allows for the interpretation of practices of ethical justification in diverse cultural contexts. I argue that this second category of ethnography is more congenial to the work of comparative religious ethicists, since an integral part of ethical inquiry involves reflecting on, and making arguments about, social norms and practices.