LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a training clinic with a primary diagnosis of social anxiety disorder as well as secondary symptoms of excessive worry and concerns of sexual identity confusion. Recent evidence suggests that gay men report more symptoms of social anxiety when compared to heterosexual men, and those who make more efforts to conceal their sexual identity experience increased anxiety and have greater difficulty committing to a personal identity. Further, it has been hypothesized that fear of rejection from heterosexual individuals underlies this anxiety. The client attended 50 sessions over the course of 18 months. Treatment progress was assessed via self-report questionnaires assessing social anxiety and worry. Consistent with principles of evidence-based practice, a cognitive behavioral treatment protocol was employed at the outset of therapy and resulted in a decline in the client's social anxiety scores. However, once the case conceptualization and treatment focus shifted to focus on sexual identity, his scores continued to decline at an even steeper rate. He ultimately came to identify himself as having a same-sex sexual orientation, began living his life in a manner consistent with that identification, and reported a number of positive outcomes at termination of therapy. Implications for treatment of social anxiety in sexual minorities are discussed.     

Towards defining a unified concept for the acceptability of Intelligent Transport Systems (ITS): A conceptual analysis based on the case of Intelligent Speed Adaptation (ISA)

A key success factor in the future implementation of new in-vehicle technologies is in understanding how users will experience and respond to these devices. Although it is recognized that acceptance, acceptability and/or support is important, consistency in the definition of acceptability, and how it can be measured, is absent. In this paper we conceptualize acceptance as the attitudes towards a new device after its introduction and acceptability as the attitudes to it before its introduction. It is our goal to describe and conceptualize the most common and relevant socio-psychological factors that can influence acceptance and acceptability of Intelligent Speed Adaptation (ISA). By analysing the different theories and methods used in ISA trials we arrived at the 14 most potential indicators that could influence the definition of acceptability and acceptance. A test survey was conducted to determine if these indicators are relevant and if they affect acceptability. The use of a factor analysis helped to single out those questions that were deemed relevant in doing our conceptual acceptability analysis, and to allocate correlations between the different items. We conclude that we have found a concept with some main possible indicators that directly influence the acceptability of ISA.     

The pattern of subjective anxiety during in-session exposures over the course of cognitive-behavioral therapy for clients with social anxiety disorder

Exposure-based therapies are efficacious treatments for social anxiety disorder (i.e., Gould et al., 1997). Much of the theory behind these treatments is derived from Foa and colleagues' (Foa, Huppert, & Cahill, 2005; Foa & Kozak, 1986) work on emotional processing. However, there has been little research examining individual differences in emotional processing patterns within and between treatment sessions among clients with social anxiety disorder. This study utilized longitudinal data analytic methods to examine changes in subjective anxiety during the first 3 exposure sessions in group and individual cognitive-behavioral therapy for social anxiety disorder. The results of this study provide preliminary evidence that, although anxiety generally decreases across exposures, some individuals experience considerable fluctuations in anxiety during a single exposure. Although anxiety during the first exposure was not significantly related to outcome, the relationship between anxiety during exposure and outcome became stronger during subsequent exposures. Overall, this study highlights the need to conduct more fine-grained analyses to better understand the mechanisms underlying exposure-based therapies for social anxiety disorder.     

Factors Influencing Employee Intentions to Provide Honest Upward Feedback Ratings

Based on current research involving rater motivation, we examined several factors hypothesized to influence employee intentions to provide honest upward feedback. Survey data were collected from a demographically diverse sample of hospital employees (n = 203). In summary, we found empirical support for generalizing extant models of rater motivation to an upward feedback context: cynicism towards upper management and the upward feedback process, understanding upward feedback, and opportunity to observe their supervisors were the primary predictors of employee intentions to provide honest upward feedback ratings, mediated by the (a) extent to which employees perceived positive benefits would result from rating their supervisors honestly, (b) the extent to which employees feared retaliation by their supervisors, and (c) rater self-efficacy.

The basolateral amygdala is necessary for learning but not relearning extinction of context conditioned fear

Extinction of conditioned fear involves new learning that inhibits but does not eliminate the original fear memory. This inhibitory learning is thought to require activation of NMDA receptors (NMDAr) within the basolateral amygdala (BLA). However, once extinction has been learned, the role played by the BLA during subsequent extinction procedures remains unknown. The present study examined the role of neuronal activity and NMDAr activation in rats receiving their first or second extinction of context fear. We found that BLA infusion of DL-APV, a competitive antagonist of NMDAr, depressed fear responses at both the first and second extinction. It impaired learning extinction but spared and even facilitated relearning extinction. BLA infusion of muscimol, a GABA(A) agonist, produced a similar outcome, suggesting that DL-APV not only blocked NMDAr-dependent plasticity but also disrupted neuronal activity. In contrast, infusion of ifenprodil, a more selective antagonist of NMDAr containing the NR2B subunit, did not depress fear responses but impaired short- and long-term inhibition of fear at both the first and second extinction. Therefore, we suggest that relearning extinction normally requires NMDAr containing the NR2B subunit in the BLA. However, simultaneous blockade of these receptors and neuronal activity in the BLA results in compensatory learning that is able to promote long-term re-extinction. These data are consistent with a current model that attributes fear extinction to interactions between several neural substrates, including the amygdala and the medial prefrontal cortex.     

What are you looking at? Infants’ neural processing of an adult's object‐directed eye gaze

Previous research suggests that by 4 months of age infants use the eye gaze of adults to guide their attention and facilitate processing of environmental information. Here we address the question of how infants process the relation between another person and an external object. We applied an ERP paradigm to investigate the neural processes underlying the perception of the direction of an adult's eye gaze in 4-month-old infants. Infants showed differential processing of an adult's eye gaze, which was directed at a simultaneously presented object compared to non-object-directed eye gaze. This distinction was evident in two ERP components: The Negative component, reflecting attentional processes, and the positive slow wave, which is involved in memory encoding. The implications of these findings for the development of joint attention and related social cognitive functions are discussed.