Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders

Comorbid substance use disorders (SUDs) and mental health disorders are a pervasive problem among post-9/11 veterans and service members. Treatment of SUD and comorbid disorders has historically occurred separately and sequentially, and when treated concurrently has been primarily done in a weekly outpatient setting, which has high rates of dropout. The current study describes an integrated 2-week intensive outpatient treatment (IOP) using cognitive-behavioral therapy, including prolonged exposure for posttraumatic stress disorder (PTSD), unified protocol for anxiety and mood disorders, and relapse prevention for SUD. Forty-two patients completed the comorbid treatment program. Results indicated that self-reported substance use, PTSD, and depression symptoms significantly decreased following treatment, while satisfaction with participation in social roles increased. These preliminary effectiveness data indicate that comorbid SUD and mental health disorders can be effectively treated in a 2-week intensive outpatient program.     

认知诊断CAT中具有非统计约束选题方法的比较

项目曝光控制和内容约束关系到测验安全、测验的信度和效度, 是计算机化自适应测验(Computerized Adaptive Testing, CAT)中两类重要的非统计约束条件。本文在认知诊断CAT中针对内容约束和项目曝光控制要求, 运用5种方法选择测验项目。它们分别是：(1) Monte Carlo方法与项目合格方法相结合, 记为MC-IE; (2) Monte Carlo方法与最大优先指标方法相结合, 记为MC-MPI; (3) Monte Carlo方法与限制阈值方法相结合, 记为MC-RT; (4) Monte Carlo方法与限制进度指标方法相结合, 记为MC-RPG以及(5) Monte Carlo方法与最大后验概率方法相结合, 记为MC-PP。然后通过在线性、收敛、发散、无结构和独立五种属性结构下构建题库并运用重参化融融统和模型模拟被试反应比较它们的选题表现。研究发现, (1) 相同选题方法在不同属性结构下项目曝光率的分布类似, 测量精度按线性、收敛、发散、无结构和独立结构的顺序依次降低; (2) 相同属性结构下, 不同方法的测量精度高低依次为MC-PP、MC-IE、MC-RT、MC-MPI和MC-RPG方法; 项目曝光均匀性优劣依次为MC-RPG、MC-MPI、MC-RT、MC-IE和MC-PP方法。统一量纲值表明, MC-RPG方法的综合表现最好, MC-MPI方法的表现次之。     

Positive affect predicts less reacquisition of fear: relevance for long-term outcomes of exposure therapy

Much emphasis in fear conditioning research is placed on understanding extinction learning, partly because of its application in treating anxiety disorders. Return of fear after extinction is a problem affecting long-term maintenance of treatment gains. The present study evaluated whether positive affect (PA) is associated with lower rates of reacquisition, or, an increase in fear following re-pairings of the conditional stimulus (CS+) and unconditional stimulus (US; e.g. electric shock) after extinction. Results showed that higher PA before and after extinction was associated with less CS+ fear during reacquisition as measured by skin conductance arousal and US expectancy. Conversely, negative affect was not associated with reacquisition of fear using any measure. These results provide implications for reducing reacquisition with exposure therapy for anxiety disorders.     

The P600 in Implicit Artificial Grammar Learning

The suitability of the artificial grammar learning (AGL) paradigm to capture relevant aspects of the acquisition of linguistic structures has been empirically tested in a number of EEG studies. Some have shown a syntax‐related P600 component, but it has not been ruled out that the AGL P600 effect is a response to surface features (e.g., subsequence familiarity) rather than the underlying syntax structure. Therefore, in this study, we controlled for the surface characteristics of the test sequences (associative chunk strength) and recorded the EEG before (baseline preference classification) and after (preference and grammaticality classification) exposure to a grammar. After exposure, a typical, centroparietal P600 effect was elicited by grammatical violations and not by unfamiliar subsequences, suggesting that the AGL P600 effect signals a response to structural irregularities. Moreover, preference and grammaticality classification showed a qualitatively similar ERP profile, strengthening the idea that the implicit structural mere‐exposure paradigm in combination with preference classification is a suitable alternative to the traditional grammaticality classification test.     

中小学生的灾难暴露程度对创伤后应激障碍的影响：中介和调节效应

汶川地震后1年时,采用灾难暴露程度问卷、主观害怕程度问卷、社会支持问卷和创伤后应激障碍症状量表,对地震极重灾区的3058名中小学生进行调查,考察灾难暴露程度、主观害怕程度、社会支持与创伤后应激障碍的关系。结果发现：（1）震后1年时中小学生创伤后应激障碍的发生率为9.6%,其中有目睹他人死亡经历的学生的创伤后应激障碍发生率为16.2%;（2）灾难暴露程度能正向预测创伤后应激障碍,而主观害怕程度在灾难暴露程度对创伤后应激障碍的影响中起部分中介作用;（3）社会支持在灾难暴露程度与创伤后应激障碍的关系中起调节作用,但不能调节主观害怕程度与创伤后应激障碍之间的关系。其中,无论支持的性质如何,父母和教师的支持都能缓解灾难暴露程度对创伤后应激障碍的影响,而同学和其他人的支持则不具有调节效应。     

Anxiety sensitivity and posttraumatic stress among traumatic event-exposed youth

Total and factor scores of the Childhood Anxiety Sensitivity Index (CASI) were examined in relation to posttraumatic stress symptom levels within a community-based sample of 68 (43 females) traumatic event-exposed youth between the ages of 10 and 17 years (M_age=14.74 years). Findings were consistent with hypotheses; global anxiety sensitivity (AS) levels, as well as disease, unsteady, and mental incapacitation concerns, related positively to posttraumatic stress levels, whereas social concerns were unrelated to symptom levels. These results suggest that fears of the physical and mental consequences of anxiety are associated with relatively higher levels of posttraumatic stress subsequent to traumatic event exposure. Findings are discussed in terms of potential implications for the role of AS in developmentally sensitive etiological models of posttraumatic stress disorder (PTSD).     

Selective exposure and decision framing: The impact of gain and loss framing on confirmatory information search after decisions

When people make decisions, they often prefer to receive information that supports rather than conflicts with their decision. To date, this effect has mainly been investigated in the context of decisions about gains, whereas decisions about losses have received less attention. Based on Prospect Theory, we expected information search to be differently affected by whether people previously have decided about gains or losses. Three studies have revealed that selectivity of information search is stronger after gain-framed rather than after loss-framed decision problems. An investigation of the underlying psychological processes revealed that gain decisions are made with increased subjective decision certainty (i.e. they are easier and less effortful to make), which in turn systematically increases confirmatory information search.     

焦虑障碍的虚拟现实暴露疗法研究述评

虚拟现实暴露疗法(VRET)是传统的行为疗法的一种转换形式, 也是经典的现实情境暴露疗法的替代性治疗形式。虚拟现实整合了即时计算机图形学、身体感觉传感、视觉成像技术, 给来访者提供近似真实的、可以沉浸(immersion)和交互作用的虚拟环境。研究者采用虚拟现实暴露疗法治疗幽闭恐怖症、恐高症、飞行恐怖症、创伤后应激障碍、惊恐障碍等焦虑障碍, 并且关注虚拟现实暴露疗法的认知机制以及心理生理机制。实验研究表明, 虚拟现实暴露疗法在治疗焦虑障碍时是有效的。被试经过治疗之后, 对情境的控制感和自我效能感提升, 消极自我评价降低, 对创伤事件的容忍力提高, 重新获得对情境的控制感。与心率指标相比, 皮肤电是预测虚拟现实暴露疗法治疗效果更好的指标。虚拟现实暴露疗法还处于实验验证阶段, 并没有应用到实际临床中, 需要更加规范的实验设计验证该疗法的认知机制以及心理生理机制。虚拟现实暴露疗法结合功能磁共振成像(FMRI)用于心理治疗, 会是未来发展的新方向。     

Introduction to the Special Series: Clinical Applications of the Inhibitory Learning Model

Exposure therapies (ETs) are treatments of choice for a number of mental health disorders, particularly anxiety and associated conditions, and problems due to avoidance. Exposure has received broad empirical support as a primary intervention. Recent efforts have focused on improving the efficacy and acceptability of exposure-based treatments. As proposed by Craske etal. (2014), strategies to improve ETs based on the inhibitory learning model have shown notable promise. However, surveys suggest that clinicians continue to avoid ETs, or implement them in a manner that interrupts their efficacy. In this special series, articles focus on specific inhibitory learning strategies in exposure, and their adaptation to multiple patient populations. The aim of the special series is to critically assess the research support for inhibitory learning approaches to exposure, and provide guidance for clinicians to implement these strategies in everyday practice.     

Interactive effects of cumulative lifetime traumatic brain injuries and combat exposure on posttraumatic stress among deployed military personnel

Growing research links Traumatic Brain Injury (TBI) with greater posttraumatic stress disorder (PTSD) symptoms. Much of this research has focused on the influence of the presence or severity of a single TBI while neglecting the potential cumulative effects of multiple TBIs incurred across an individual’s lifetime on combat-related PTSD. The present study addressed this gap using a sample of 157 military service members and 4 civilian contractors who underwent structured TBI interviews at a military hospital in Iraq and completed the Combat Experiences Scale (CES) and Posttraumatic Checklist – Military (PCL-M). Results indicated that a greater number of lifetime TBIs were associated with greater PTSD symptoms when accounting for the presence and severity of a recent, deployment-related TBI. Additionally, a significant interaction of number of lifetime TBIs and combat exposure emerged, indicating that exposure to combat yielded greater PTSD symptoms among those with multiple lifetime TBIs compared to those with one or zero lifetime TBIs. These data suggest that incurring multiple TBIs may amplify the link between combat exposure and PTSD and underscore the need to screen for lifetime TBI history.