Cognitive-behavioral therapy for insomnia in alcohol dependent patients: a randomized controlled pilot trial

In a randomized controlled trial, we evaluated the efficacy of cognitive-behavioral treatment for insomnia to improve sleep and daytime symptoms, and to reduce relapse in recovering alcohol dependent (AD) participants. Seventeen abstinent AD patients with insomnia (6 women, mean age 46.2 ± 10.1 years) were randomized to 8 sessions of cognitive-behavioral treatment for insomnia for AD (CBTI-AD, n = 9) or to a behavioral placebo treatment (BPT, n = 8). Subjective measures of sleep, daytime consequences of insomnia and AD, alcohol use, and treatment fidelity were collected at baseline and post-treatment. Diary-rated sleep efficiency and wake after sleep onset, and daytime ratings of General Fatigue on the Multidimensional Fatigue Inventory improved more in the CBTI-AD compared to the BPT group. In addition, more subjects were classified as treatment responders following CBTI-AD. No group differences were found in the number of participants who relapsed to any drinking or who relapsed to heavy drinking. The findings suggest that cognitive-behavioral insomnia therapy benefits subjective sleep and daytime symptoms in recovering AD participants with insomnia more than placebo. The benefits of treating insomnia on drinking outcomes are less apparent.     

More than fair: Outcome dependence, system justification, and the perceived legitimacy of authority figures

Legitimacy is a source of power for authorities because it promotes voluntary deference on the part of followers. From a system justification perspective, there is also reason to believe that power is a source of perceived legitimacy. We report five studies demonstrating that in addition to procedural fairness and outcome favorability, outcome dependence is an independent contributor to perceived legitimacy. In two cross-sectional field studies and one panel study, we hypothesized and found that dependence on an authority figure is positively associated with appraisals of legitimacy, measured in terms of trust and confidence in, empowerment of, and deference to authority. These effects were demonstrated in educational, political, and legal settings. Two additional experiments provided direct causal evidence for the hypothesized effect on both perceived legitimacy and voluntary deference (i.e., acquiescence to additional requests). We also found that participants assigned to a high (vs. low) dependence condition judged their outcomes to be more favorable, despite the fact that the outcomes were identical in the two conditions; this effect was mediated by perceived legitimacy. Taken as a whole, these findings suggest that perceived legitimacy is enhanced not only when authorities exercise fair procedures and deliver favorable outcomes, but also when subordinates are dependent on them. Implications for society and the study of legitimacy and social power are discussed.     

Silicon in ‘pure gold’? Theoretical contributions and observations on teleanalysis by videoconference

Ideas about psychoanalysis via videoconference—videoconference teleanalysis (VT)—are presented with the general understanding that these settings produce a twofold split between various degrees of recognition/negativisation of the absence of the other, on one hand, and the expectation of physical co‐presence, on the other. This split has been put forward as dismantling the here, now, with me pre‐reflexive unity of the analytic experience. This article suggests that both members of the analytic dyad will seek to reappropriate the experience through a forced ego integration that interferes with accessing states of unintegration in the analytic treatment and produces subtle alterations to symbolisation work. The effort to overcome this condition is illustrated with clinical vignettes and therapists’ comments about feelings of inauthenticity and discontent when trying to sustain evenly‐suspended attention, as well as in the perception of a form of flattening of the alive nature of speech. However, this is not a constant for all VT, and mutual understanding can be an important mitigating feature. The focus of the discussion should be on the capacity of the analytic dyad to overcome such a split and not on a direct extrapolation of the perceptual limitations of VT to possible effects on transference / countertransference.     

Do PTSD symptoms and course predict continued substance use for homeless individuals in contingency management for cocaine dependence?

Homeless individuals (n = 187) entering contingency management (CM) for cocaine dependence were assessed for PTSD diagnosis, and a subset of 102 participants reporting traumatic exposure also periodically completed a self-report measure of PTSD symptoms. Patients with PTSD in full remission at 6 months (end of active treatment) and 12 months (end of aftercare) used substances much less frequently during aftercare than those with no PTSD diagnosis. Those whose PTSD diagnosis improved to full remission status during active treatment, and remained in full remission at 12 months, also had superior substance use outcomes. Severity of PTSD symptoms at 6 months, but not baseline or 2 months, was associated with substance use across treatment phases. Substance use during aftercare, however, was better predicted by changes in PTSD symptom severity. Patients whose PTSD symptoms improved more during active treatment fared better during aftercare than those with less improvement. Findings suggest homeless individuals with comorbid PTSD entering CM for cocaine dependence are not necessarily at increased risk for substance use compared to those without the comorbidity. However, course of PTSD does predict substance use, with the potential for CM to be unusually effective for those who respond with substantial, lasting improvements in PTSD.     

Pharmacologic and Behavioral Withdrawal From Addictive Drugs

ABSTRACT— Recent theories suggest that drug withdrawal does not motivate drug use and relapse. However, data now show that withdrawal produces complex changes over time in at least two symptoms (i.e., negative affect and urges) that are highly predictive of relapse. Evidence suggests that falling levels of the drug in the blood and interruption of the drug self-administration ritual both affect these symptoms. Both of these forms of withdrawal motivate renewed drug use in addicted individuals.     

Replication of the Self-Concept and Identity Measure (SCIM) Among a Treatment-Seeking Sample

Identity distress occurs within a variety of psychiatric conditions. Reliable tools for assessing identity-related functioning among clinical populations are greatly needed. The Self-Concept and Identity Measure (SCIM) is a brief self-report scale designed to assess healthy and disturbed identity dimensions. This measure has been validated within normative but not treatment-seeking samples. The present study used an a priori confirmatory approach to replicate the SCIM’s factor structure among disadvantaged women enrolled in treatment for chemical dependence (N = 216). The original three-factor structure and item loadings generally replicated within this diagnostically diverse, significantly impaired sample. Higher SCIM scores were also associated with other problems, such as emotion dysregulation and depression. Results support the SCIM’s use and scoring with clinical populations.     

Comparison of interventions to treat prompt dependence for children with developmental disabilities

Prior research has examined interventions to prevent prompt dependence from occurring during the training of novel skills. Nevertheless, the relative efficacy and efficiency of different intervention procedures may be idiosyncratic across learners, suggesting the potential benefit of an individualized assessment. The purpose of the current study was to extend the literature on prompt dependence by comparing interventions for 3 participants with developmental disabilities who consistently engaged in correct responses following prompts but did not perform tasks independently. We compared the efficacy and efficiency of 3 interventions including differential reinforcement, prompt fading, and extended response interval. Intervention results differed across participants, indicating that the most efficacious and efficient intervention for prompt dependence should be individualized via assessment.     

Two types of serial dependence in visual working memory

Stimulus representations in working memory depend on memory traces of past stimuli both from previous trials and from the current trial. However, it is unclear whether the same or different mechanisms underlie this serial dependence across and within trials. We directly contrasted estimates of bias for pairs of immediately successive stimuli across and within trials. In each trial, participants memorized two consecutive motion direction stimuli (S1 and S2) and after a short delay were cued to report one of them. We found serial dependence across trials: The current S1 was attracted towards the preceding S2 when the latter had been cued for report. In contrast, within the same trial S2 was repulsed from S1. In addition, repulsion within a trial occurred for a broader range of motion direction differences between stimuli than attraction across trials. A second experiment in which 25% of trials did not require a response demonstrated that across‐trial attraction did not depend on whether the previous S2 actually had to be reported. Our findings provide evidence for two types of serial dependence operating across and within trials. They support the notion of different mechanisms integrating or segregating current from similar past memory contents depending on their task relevance.     

Ten-month-olds' selective use of visual dimensions in category learning

There is now general consensus that infants can use several different visual properties as the basis for categorization. Nonetheless, little is known about when and whether infants can be guided by contextual information to select the relevant properties from amongst those available to them. We show here that by 10 months of age infants can be biased, through observational learning, to use one or the other of two object properties for classification. Two groups of infants watched an actress classifying objects by either shape (the Shape group) or surface pattern (the Pattern group). When subsequently presented with two test trials which contradicted either one or the other of the classification rules, infants in the two groups looked longer to the classification event that was incompatible with the rule that group had been familiarized to. These results are discussed with reference to the development of selective feature processing in infancy.     

Is Structure Dependence an Innate Constraint? New Experimental Evidence From Children's Complex‐Question Production

According to Crain and Nakayama (1987) , when forming complex yes/no questions, children do not make errors such as Is the boy who smoking is crazy? because they have innate knowledge of structure dependence and so will not move the auxiliary from the relative clause. However, simple recurrent networks are also able to avoid such errors, on the basis of surface distributional properties of the input ( Lewis & Elman, 2001 ; Reali & Christiansen, 2005 ). Two new elicited production studies revealed that (a) children occasionally produce structure‐dependence errors and (b) the pattern of children's auxiliary‐doubling errors (Is the boy who is smoking is crazy?) suggests a sensitivity to surface co‐occurrence patterns in the input. This article concludes that current data do not provide any support for the claim that structure dependence is an innate constraint, and that it is possible that children form a structure‐dependent grammar on the basis of exposure to input that exhibits this property.