The Divergent Paths of Behavior Analysis and Psychology: Vive la Différence!

Twenty years ago I suggested that behavior analysts could effect a quiet and covert takeover of the American Psychological Association (APA). I gave as precedents the operation of similar initiatives in the nineteenth and twentieth centuries, the Darwinian-inspired X-Club, and the psychoanalytically-oriented Secret Ring. Though a conscientious program of working within established APA bylaws and rules, behavior analysts could ensure that behavior analysts were nominated for every significant elective position within the APA, and move to get their colleagues placed in appointive positions, such as journal editorships, review boards, and major committees. This would be one approach to remake psychology along behavioral lines, which was an early ambition of B. F. Skinner. The community of behavior analysts ignored my suggestion, and instead pursued the path of creating an independent discipline of practitioners, one with its own degree-granting programs, conventions, journals, and legal regulation. This effort has been immensely successful, although much critical work remains to be done. In retrospect, I was wrong to suggest changing psychology from within, and I have been delighted to witness the emergence of our new and independent field.     

影响晚期胃癌患者生活质量的因素分析

分析晚期胃癌患者的生活质量情况及其影响因素,为晚期胃癌患者的临床护理干预提供科研数据.选择2010年5月至2011年5月在辽宁医学院附属第一医院胃肠外科及肿瘤科的晚期胃癌患者173名进行生活质量的乱查,并通过EORTC QLQ —C30,SSRS,MCMQ,SAS等量表和一般人口学资料及临床病例资料进行评估.晚期胃癌患者总体生活质量评分低,仅29.54±12.21;社会支持、医学应对方式、焦虑及患者临床资料(除放疗外)对晚期胃癌患者总体生活质量影响较明显(P＜0.05).晚期胃癌患者的生活质量较差,其影响因素是多方面的,临床上医务人员应采取必要的措施提高晚期胃癌患者的生活质量.     

Predicting Persistence of Nonsuicidal Self‐Injury in Suicidal Adolescents

Prospective predictors of persistent nonsuicidal self‐injury (NSSI) were examined in adolescents admitted to an inpatient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months. Seventy‐one (77%) participants reported NSSI at baseline, and 40 (56%) persisted at the 6 month follow‐up. Those who endorsed automatic positive reinforcement (APR) as the predominant reason for NSSI were more likely to persist in NSSI. Depression over follow‐up, but not at baseline, also predicted persistence. These results suggest that helping high‐risk adolescents to identify alternative ways of generating emotion(s) to counter the effects of APR that may accompany NSSI should be a high priority treatment target.     

Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline

We examined the impact of the implementation of Applied Suicide Intervention Skills Training (ASIST) across the National Suicide Prevention Lifeline's national network of crisis hotlines. Data were derived from 1,507 monitored calls from 1,410 suicidal individuals to 17 Lifeline centers in 2008–2009. Callers were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by ASIST‐trained counselors. Few significant changes in ASIST‐trained counselors' interventions emerged; however, improvements in callers' outcomes were linked to ASIST‐related counselor interventions, including exploring reasons for living and informal support contacts. ASIST training did not yield more comprehensive suicide risk assessments.     

I Can Stomach That! Fearlessness About Death Predicts Attenuated Facial Electromyography Activity in Response to Death‐Related Images

Objective measures of suicide risk can convey life‐saving information to clinicians, but few such measures exist. This study examined an objective measure of fearlessness about death (FAD), testing whether FAD relates to self‐reported and physiological aversion to death. Females (n = 87) reported FAD and disgust sensitivity, and facial electromyography was used to measure physiological facial responses consistent with disgust while viewing death‐related images. FAD predicted attenuated expression of physiological death aversion, even when controlling for self‐reported death‐related disgust sensitivity. Diminished physiological aversion to death‐related stimuli holds promise as an objective measure of FAD and suicide risk.     

Neurocognitive Function and Suicide in U.S. Army Soldiers

This prospective cohort study used administrative data from the Army Study to Assess Risk and Resilience in Servicemembers to examine associations between neurocognitive functioning and subsequent suicidal events among Regular Army enlisted soldiers during the years 2004–2009. Cases were all soldiers who completed the Army's Automated Neuropsychological Assessment Metrics (ANAM) computerized testing battery prior to documented suicide attempt (n = 607), ideation (n = 955), or death (n = 57). Controls were an equal‐probability sample of 9,893 person‐months from other soldiers. Exploratory factor analysis of five ANAM tests identified a general neurocognitive factor that excluded the mathematic processing test (MTH). When examined separately in logistic regression analyses that controlled for sociodemographics and prior mental health diagnosis, both the general neurocognitive factor (logit [β] = ?.197 to ?.521; p < .01) and MTH (β = ?.024 to ?.064; p < .05) were associated with all outcomes. When both predictors were examined simultaneously, the general neurocognitive factor continued to be associated with all outcomes (β = ?.164 to ?.417; p < .05) and MTH continued to be associated with suicide attempt (β = ?.015; p = .046) and ideation (β = ?.014; p = .018). These small but robust associations suggest that future research must continue to examine the extent to which objective neurocognitive tests may enhance understanding and prediction of suicide risk.     

Mental Disorders,Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre‐enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention‐deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre‐enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.