Comparing the effects of differential reinforcement of other behavior and response-cost contingencies on tics in youth with tourette syndrome

Tics are rapid, repetitive, stereotyped movements or vocalizations that arise from neurobiological dysfunction and are influenced by environmental factors. Although persons with tic disorders often experience aversive social reactions in response to tics, little is known about the behavioral effects of such consequences. Along several dimensions, the present study compared the effects of two treatments on tics: response cost (RC) and differential reinforcement of other behavior (DRO). Four children with Tourette syndrome were exposed to free-to-tic baseline, DRO, RC, and quasibaseline rebound evaluation conditions using an alternating treatments design. Both DRO and RC produced substantial decreases in tics from baseline levels. No differential effects of DRO and RC contingencies were seen on self-reported stress or in the strength of the reflexive motivating operation (i.e., premonitory urge) believed to trigger tics, and neither condition produced tic-rebound effects. Implications of these findings and directions for future research are discussed.     

Family Functioning in Pediatric Trichotillomania

Little is known about how pediatric trichotillomania (TTM), a clinically significant and functionally impairing disorder, is impacted by, and impacts, family functioning. We explored dimensions of family functioning and parental attitudes in a sample of children and adolescents who participated in an Internet-based survey and satisfied conservative diagnostic criteria for TTM (ages 10–17, n = 133). Analyses reveal trends toward higher levels of dysfunction in families of TTM youth relative to normative samples, although no differences achieved statistical significance. However, scores on the Family Assessment Measure and the Attitudes Toward My Child scales were similar to those in clinical samples of youth with cystic fibrosis, an eating disorder, or an anxiety disorder. While these results indicate that family functioning and parental attitudes in TTM were not generally or extremely problematic, family issues may nevertheless warrant particular clinical evaluation and attention in more severe TTM cases.     

Putting false memories into context: the effects of odour contexts on correct and false recall*

ABSTRACT

False memories created by the Deese/Roediger-McDermott (DRM) paradigm are often accompanied by contextual information. Yet, research investigating the effects of context on false memories is surprisingly scarce. We used the context-dependent memory (CDM) model to construct same versus different context conditions using odours as contexts and DRM lists as to-be-remembered stimuli. Experiment 1 showed that levels of correct recall were higher in the same-context condition than in the changed-context condition, but no effects of context were observed in false recall. Experiment 2 used different odours and a longer retention interval and showed that context-dependent memory effects were found for both true and false memory. For true memory, context reinstatement improved memory, whilst simultaneously reducing false memory. Theoretical and forensic implications of these findings are discussed.     

Mechanisms of change in cognitive behavioral therapy for panic disorder: The unique effects of self-efficacy and anxiety sensitivity

The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment.     

The Interactive Contributions of Perceived Control and Anxiety Sensitivity in Panic Disorder: A Triple Vulnerabilities Perspective

Within the triple vulnerabilities model of anxiety disorders, a genetic contribution to the development of anxiety and negative affect (i.e., generalized biological vulnerability), a diminished sense of perceived control over aversive events and emotional experiences (i.e., generalized psychological vulnerability), and elevated levels of anxiety sensitivity (i.e., specific psychological vulnerability) are posited to increase the risk of developing and maintaining panic disorder (Barlow American Psychologist 55(11):1247–1263, 2000). The purpose of the present study was to investigate the direct and interactive effects of perceived control and anxiety sensitivity on panic disorder symptom severity. Structural equation models (SEM) were conducted in data derived from a sample of 379 adults with panic disorder participating in a multi-site randomized controlled trial. Findings indicated that both perceived control and anxiety sensitivity uniquely predicted panic disorder symptoms. A moderation model examining the interactive effects of perceived control and anxiety sensitivity on panic symptoms indicated that the effect of anxiety sensitivity on panic symptoms increased with greater deficits in perceived control. The present findings suggest that deficits in perceived control and elevated levels of anxiety sensitivity exert unique and shared effects on panic disorder symptoms, thereby illustrating the relationship between putative vulnerability factors and panic disorder symptoms as predicted by the triple vulnerabilities model.     

Blame Conformity: Leading Eyewitness Statements can Influence Attributions of Blame for an Accident

The present experiment examined whether attributions of blame for an incident can be shifted between individuals as a result of a leading eyewitness statement. Participants watched a video of an accident involving two men and then read either a non‐leading eyewitness statement that blamed no one for the accident or a leading eyewitness statement that blamed one of the two men for the accident. Participants' attributions of blame for the accident were then assessed either immediately or after a 1 week delay. Regardless of the time delay, just over one‐third of participants who read a leading statement subsequently blamed the same person as the eyewitness. In contrast, less than 4% of participants who read a non‐leading statement blamed one of the men. This research is the first to demonstrate blame conformity, where blame for an incident can be shifted between individuals as a result of a leading eyewitness statement. Copyright © 2013 John Wiley & Sons, Ltd.     

Preventive work in a toddler group and nursery

This paper is about the sort of preventive work which can be carried out in early child care settings where incipient disturbance can be picked up and worked with promptly and effectively. It shows how toddler groups and nurseries can offer relationships and experiences which encourage mutuality and progressive development, while at the same time addressing difficulties before they have become fully internalized. It gives a detailed account of work with a single mother and her son who attended first a toddler group run by a child psychotherapist and her trainee assistant, and then a nursery where staff were in regular consultation with the child psychotherapist who also worked individually with the mother. It argues that the effectiveness of such early interventions can be conceptualized in terms of supplying maternal and paternal functioning at a time when children and parents alike are particularly needful of and responsive to this sort of help.     

Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome

Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed.