Treatment manuals: use in the treatment of bulimia nervosa

As psychology has moved toward emphasizing evidence-based practice, use of treatment manuals has extended from research trials into clinical practice. Minimal research has directly evaluated use of manuals in clinical practice. This survey of international eating disorder professionals examined use of manuals with 259 clinicians’ most recent client with bulimia nervosa. Although evidence-based manuals for bulimia nervosa exist, only 35.9% of clinicians reported using a manual. Clinicians were more likely to use a manual if they were younger; were treating an adult client; were clinical psychologists; were involved in research related to eating disorders; and endorsed a cognitive-behavioral orientation. Clinicians were less likely to use a manual if they provided eclectic psychotherapy that incorporated multiple psychotherapeutic approaches. We conclude that psychotherapy provided in clinical practice often does not align with the specific form validated in research trials, and “eclecticism” is at odds with efforts to disseminate manuals into clinical practice.     

Anatomic Magnetic Resonance Imaging of the Developing Child and Adolescent Brain and Effects of Genetic Variation

Magnetic resonance imaging studies have begun to map effects of genetic variation on trajectories of brain development. Longitudinal studies of children and adolescents demonstrate a general pattern of childhood peaks of gray matter followed by adolescent declines, functional and structural increases in connectivity and integrative processing, and a changing balance between limbic/subcortical and frontal lobe functions, which extends well into young adulthood. Twin studies have demonstrated that genetic factors are responsible for a significant amount of variation in pediatric brain morphometry. Longitudinal studies have shown specific genetic polymorphisms affect rates of cortical changes associated with maturation. Although over-interpretation and premature application of neuroimaging findings for diagnostic purposes remains a risk, converging data from multiple imaging modalities is beginning to elucidate the influences of genetic factors on brain development and implications of maturational changes for cognition, emotion, and behavior.     

A component analysis of a parent‐conducted multi‐component treatment for food selectivity

Treatment packages including differential reinforcement of alternative (DRA) behavior and escape prevention in the form of a non‐removal of the spoon procedure have been shown to successfully increase food consumption. However, when these treatment components are introduced simultaneously, the treatment component(s) responsible for behavior change cannot be determined. The purpose of this study was to conduct a sequential component analysis of the following treatment components: Bite fading, manipulation of reinforcer magnitude, and escape prevention. For two participants, food consumption did not increase until after escape prevention was introduced. For one participant, increased food consumption was observed after the magnitude of reinforcement was increased; therefore, escape prevention was not necessary. Results were maintained at a 12‐week follow‐up for all participants. Copyright © 2010 John Wiley & Sons, Ltd.     

Functional analyses and treatment of precursor behavior

Functional analysis has been demonstrated to be an effective method to identify environmental variables that maintain problem behavior. However, there are cases when conducting functional analyses of severe problem behavior may be contraindicated. The current study applied functional analysis procedures to a class of behavior that preceded severe problem behavior (precursor behavior) and evaluated treatments based on the outcomes of the functional analyses of precursor behavior. Responding for all participants was differentiated during the functional analyses, and individualized treatments eliminated precursor behavior. These results suggest that functional analysis of precursor behavior may offer an alternative, indirect method to assess the operant function of severe problem behavior.     

Interpersonal consequences of forgiveness: Does forgiveness deter or encourage repeat offenses?

Benefits of forgiveness have been well documented, but past research has not directly addressed the crucial question of whether forgiveness deters or invites repeat transgressions. Our research indicates that expressing forgiveness typically discourages future offenses. In Study 1, participants playing a form of the prisoner’s dilemma game were more likely to repeat their transgressions against unforgiving victims than forgiving victims, especially when victims had no chance to retaliate. In response to a hypothetical scenario presented in Study 2, participants reported that they would be less likely to risk offending someone for a second time if that person had forgiven their first offense. In Study 3, participants’ autobiographical recollections of their prior transgressions revealed that receiving forgiveness predicted higher repentance motivation.     

Employability of Genetic Counselors with a PhD in Genetic Counseling

The development of a PhD in genetic counseling has been discussed for more than 20 years, yet the perspectives of employers have not been assessed. The goal of this qualitative study was to gain an understanding of the employability of genetic counselors with a PhD in genetic counseling by conducting interviews with United States employers of genetic counselors. Study participants were categorized according to one of the following practice areas: academic, clinical, government, industry, laboratory, or research. All participants were responsible for hiring genetic counselors in their institutions. Of the 30 employers interviewed, 23 envisioned opportunities for individuals with a PhD degree in genetic counseling, particularly in academic and research settings. Performing research and having the ability to be a principal investigator on a grant was the primary role envisioned for these individuals by 22/30 participants. Employers expect individuals with a PhD in genetic counseling to perform different roles than MS genetic counselors with a master's degree. This study suggests there is an employment niche for individuals who have a PhD in genetic counseling that complements, and does not compete with, master's prepared genetic counselors.     

Losing a training analyst for ethical violations: A candidate's perspective

The author presents her experience as the analysand of a training analyst who was investigated and expelled for ethical violations with another patient, including sexual-boundary violations, during her analytic training. While boundary violations by training analysts are not uncommon, the particular trauma experienced by 'bystanders' such as candidates and supervisees is not discussed in the literature, nor the response of institutes to the educational problems that are generated. The author illustrates the complications for candidates that arise from the dual roles of training analyst as educator and analyst when he or she faces investigation or censure, including isolation and secrecy, which promote various splits in the candidate, analytic dyad and group, as well as loyalty conflicts. The discussion covers three phases of the author's experience as a candidate-analysand, namely the period encompassing the institute's ethics investigation, the announcement of findings to her and to the institute as a group, and the ensuing individual and group dynamics generated by her analyst's expulsion from the institute and revocation of his medical license. Theoretical perspectives are utilized to understand the group regression, including contamination and contagion fears, which occurred in the wake of the training analyst's expulsion, and the impact of these processes on the candidate, including the pressure to function as a 'container' for projections of the group. Implications and recommendations for candidates and institutes are made for dealing helpfully with trainees who are affected by the process of dealing with a training analyst's ethical violations. Short-term and longer-term outcomes of the experience are considered.     

Treatment of rumination maintained by automatic reinforcement: a comparison of extra portions during a meal and supplemental post‐meal feedings

This study evaluated the effects of two satiation procedures, large portions and supplementary feedings, as interventions for rumination maintained by automatic reinforcement for an individual with developmental disabilities. Results showed that supplemental feedings produced a greater reduction in the rate of rumination than the large portions treatment. Additionally, 30 min supplemental feedings were more effective than 15 min supplemental feedings. Copyright © 2007 John Wiley & Sons, Ltd.     

Reduction of appeasement‐related affect as a concomitant of diazepam‐induced aggression: evidence for a link between aggression and the expression of self‐conscious emotions

Aggressive responding following benzodiazepine ingestion has been recorded in both experimental and client populations, however, the mechanism responsible for this outcome is unclear. The goal of this study was to identify an affective concomitant linked to diazepam‐induced aggression that might be responsible for this relationship. Thirty males (15 diazepam and 15 placebo) participated in the Taylor Aggression Paradigm while covertly being videotaped. The videotapes were analyzed using the Facial Action Coding System with the goal of identifying facial expression differences between the two groups. Relative to placebo participants, diazepam participants selected significantly higher shock settings for their opponents, consistent with past findings using this paradigm. Diazepam participants also engaged in significantly fewer appeasement expressions (associated with the self‐conscious emotions) during the task, although there were no group differences for other emotion expressions or for movements in general. Aggr. Behav. 35:203–212, 2009. © 2008 Wiley‐Liss, Inc.     

Mapping Gray’s BIS and BAS constructs onto Factor 1 and Factor 2 of Hare’s Psychopathy Checklist – Revised

Reinforcement sensitivity theory (RST; Gray, 1987; Gray & McNaughton, 2000) has proven to be a valuable tool for understanding psychopathy (e.g., Fowles, 1980, 1988; Newman & Malterer, 2009; Poythress et al., 2008). Recent research has linked two RST constructs, the Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS), to individuals with primary psychopathy and secondary psychopathy (Lykken, 1995; Newman, MacCoon, Vaughn, & Sadeh, 2005): Primary psychopaths manifest low BIS reactivity and secondary psychopaths manifest high BAS reactivity. In the present study, we examine the relationships between the BIS/BAS constructs and Factors 1 and 2 of the Psychopathy Checklist – Revised (PCL-R) in a sample of 472 incarcerated male offenders. Paralleling their relationships with primary and secondary psychopathy, the BIS/BAS constructs were differentially related to the two PCL-R factors. Specifically, the influence of the BIS was found to be more prominent than the influence of the BAS for Factor 1, and the influence of the BAS was more prominent than that of the BIS for Factor 2.