Written Exposure Therapy for Suicide in a Psychiatric Inpatient Unit: A Case Series

Patients with posttraumatic stress disorder (PTSD) are at an elevated risk of suicide. For patients hospitalized for suicide risk, psychosocial treatment and stabilization are routinely offered; however, the availability of evidence-based, manualized therapeutic interventions for PTSD is sparse. Typically, the short duration of hospitalization makes it difficult to accommodate evidence-based, trauma-focused treatments. This article presents the clinical course of four active-duty service members with PTSD who were hospitalized in a psychiatric inpatient unit for acute suicide risk and treated with Written Exposure Therapy for Suicide (WET-S). WET-S is a brief, five-session therapy based upon Written Exposure Therapy and augmented with Crisis Response Planning for Suicide Prevention. Both posttraumatic stress symptoms and suicidal ideation were reduced from pre- to posttreatment for three of the four patients treated. WET-S shows promise as a manualized therapeutic intervention that can be delivered on an inpatient psychiatric unit.     

Analyzing pedestrian behavior when crossing urban roads by combining RP and SP data

Considering the high crash rates involving pedestrians on urban roads, it is highly relevant to understanding pedestrian crossing behavior. This paper is the first to combine stated preference (SP) and revealed preference (RP) data to evaluate the impact that individual attributes, trip characteristics, built environment, strategies to prevent unauthorized crossing, and traffic flows have on pedestrians crossing decisions in an urban context. SP and RP surveys were designed and collected in Barranquilla (Colombia) near pedestrian bridges or signalized intersections where direct crossings and a high concentration of pedestrian fatalities related to traffic accidents exist. A logit model was estimated using the data enrichment paradigm. Results show that pedestrians weigh risks and costs when choosing how to cross the road. The trajectories observed in the RP component suggest that people prefer direct crossings; nevertheless, pedestrian bridges and signalized intersections can be attractive alternatives if their location matches the origin or destination of the crossing, and no detour is needed to use them. Waiting time; safety; the fine imposed for jaywalking; personal security, and previous decisions are also variables that influence pedestrian behavior when crossing urban roads. These results can be helpful to urban planners and decision-makers interested in proposing appropriate pedestrian infrastructure. The data pooling technique and the inclusion of a cost-related variable (i.e., fine) allowed computing the willingness to pay and marginal substitution rates for attributes of the built environment and other characteristics associated with the crossing decision. Also, the inclusion of several crossing alternatives and situations allowed assessing pedestrian crossing preferences under different scenarios.     

A method in modeling interactive pedestrian crossing and driver yielding decisions during their interactions at intersections

Investigating pedestrian crossing and driver yielding decisions should be an important focus considering the high risks of pedestrians in exposed to motorized traffic. Limitations, however, exist in previous studies – variables considered previously have been limited; how their behavior affect each other (defined as interactive impacts) were not sufficiently considered. This paper aims to provide a methodological approach for pedestrian crossing and driver yielding decisions during their interactions, considering of different variable types including interactive impact variables, traffic condition variables, road design variables, and environment variables. A Distance-Velocity (DV) framework proposed in an earlier study is introduced for definitions and concepts in studying pedestrian-vehicle interactions. Logistic regression, support vector machines, neural networks and random forests, are introduced as candidate models. A case study involving six crosswalk locations is conducted, focusing on interactions between pedestrians and right-turn vehicles. The proposed methodological approach is applied, with the performance of the four machine learning methods compared in terms of model generalization and confusion matrix. The model with the best performance is further compared to the typical gap-based model. Results show that random forest and logistic regression models performed the best in modeling pedestrian crossing and driver yielding decisions respective, in terms of model generalization. Besides, the DV-based modeling method (average accuracy of over 90% for pedestrians and 80% for drivers) outperformed the traditional gap-based method in all test seeds. As a key finding, interactive impacts from each other (the pedestrian and the driver) act as a key contributing variable on their decisions.     

Evaluating the influence of approaching vehicles on pedestrian’s visual patterns and crossing behaviors at an uncontrolled crosswalk

The visual behaviors and movement characteristics of pedestrians are related to their surrounding potential safety hazards, such as approaching vehicles. This study primarily aimed to investigate the visual patterns and walking behaviors of pedestrians interacting with approaching vehicles. Field experiments were conducted at two uncontrolled crosswalks located at the Cuihua and Yanta roads in Xi’an, China. The visual performance of pedestrians was assessed using the eye tracking system from SensoMotoric Instruments (SMI). Moreover, motion trajectories of the pedestrians and approaching vehicles were obtained using an unmanned aerial vehicle. Subsequently, the visual attributes and movement trajectories of pedestrians and motion trajectories of approaching vehicles were statistically analyzed. The results showed that approaching vehicles distracted the fixation of crossing pedestrians significantly, and occupied 29.5% of the total duration of fixation; that is, pedestrians always directed more fixation points to the approaching vehicles compared to other stimuli. As a vehicle approached, pedestrians’ fixation shifted from other areas of interest to the vehicle. Moreover, an increase in the velocity of the vehicle and a closer distance between pedestrian and the vehicle resulted in an increase in the pedestrians’ duration of fixation on the approaching vehicle, and they implemented more saccades. Furthermore, approaching vehicle’s velocity and distance between pedestrian and approaching vehicle are not significantly associated with pedestrian’s movement attributes. These findings provide insights into the crossing behavior of pedestrians during pedestrian-vehicle interactions, which could assist future researchers and policy makers.     

The Gap Between Science and Practice: How Therapists Make Their Clinical Decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists’ practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists’ choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists’ theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.     

Effects of aging on whole body and segmental control while obstacle crossing under impaired sensory conditions

The ability to safely negotiate obstacles is an important component of independent mobility, requiring adaptive locomotor responses to maintain dynamic balance. This study examined the effects of aging and visual–vestibular interactions on whole-body and segmental control during obstacle crossing. Twelve young and 15 older adults walked along a straight pathway and stepped over one obstacle placed in their path. The task was completed under 4 conditions which included intact or blurred vision, and intact or perturbed vestibular information using galvanic vestibular stimulation (GVS). Global task performance significantly increased under suboptimal vision conditions. Vision also significantly influenced medial–lateral center of mass displacement, irrespective of age and GVS. Older adults demonstrated significantly greater trunk pitch and head roll angles under suboptimal vision conditions. Similar to whole-body control, no GVS effect was found for any measures of segmental control. The results indicate a significant reliance on visual but not vestibular information for locomotor control during obstacle crossing. The lack of differences in GVS effects suggests that vestibular information is not up-regulated for obstacle avoidance. This is not differentially affected by aging. In older adults, insufficient visual input appears to affect ability to minimize anterior–posterior trunk movement despite a slower obstacle crossing time and walking speed. Combined with larger medial–lateral deviation of the body COM with insufficient visual information, the older adults may be at a greater risk for imbalance or inability to recover from a possible trip when stepping over an obstacle.     

An internet survey of emotional health,treatment seeking and barriers to accessing mental health treatment among Chinese-speaking international students in Australia

The present internet survey examined the demographic characteristics of Chinese-speaking international students in Australia, psychological distress levels as measured by the Kessler-10 (K-10) Item scale, help-seeking history and preferences, as well as treatment barriers. Of the 144 respondents, 54% reported high psychological distress (mean K-10 score?=?23.96; SD?=?9.03). However, only 9% of those who were highly distressed reported they had sought mental health services in the past year. While the majority preferred help from informal social networks, they tended to favour mental health services over traditional culture-specific forms of help. Common barriers to accessing mental health services reported by respondents with high psychological distress included costs or transportation concerns, limited knowledge of available services, time constraints, the perception that symptoms were not severe enough to warrant treatment, language difficulties and lack of knowledge of symptoms of psychological distress. Although the majority preferred face-to-face treatments over internet treatments, a considerable percentage of respondents were willing to try either treatment modality. Chinese-speaking international students are a high risk group for developing psychological distress, yet they tend to underuse mental health services. Education about the effectiveness of face-to-face and online treatments may increase treatment seeking by this population.     

Pedestrians’ road crossing decisions and body parts’ movements

This study aims to examine pedestrians' crossing decision, body parts' movement and full body movement, just before and during road crossing in a simulated setup. To accomplish this, a novel experimental setup for analyzing pedestrians’ crossing behavior and motion was developed where the simulated display was synchronized with a 3D motion capturing system. Twenty participants, divided into control and an experimental time pressure group, observed sixteen short (less than 30 s) and long road (70 s or more) crossing scenarios with varying crossing opportunities. Based on the crossing opportunities they were asked to cross a 3.6 m wide one-lane one way urban road. It was found that the crossing initiation process consists of four incremental movements of body parts: the head and the shoulder first; the hip, wrist and elbow second; the knee as a separate joint, and finally the ankle. Results showed that pedestrians’ decision to cross and body parts movement are influenced by time pressure and wait time for a safe crossing opportunity. Specifically, pedestrians prepare their body parts earlier, initiate their crossing earlier, and adjust their speed to compensate for the risk taken in less safe or non-safe crossing opportunities. Within the control group, women tended to be more risk avoiding than men, however those differences disappeared in the time pressure group. Most importantly, the findings provide initial evidence that this novel simulation configuration can be used to gain precise knowledge of pedestrians’ decision-making and movement processes.     

Investigating the effectiveness of perceptual treatments on a crest vertical curve: A driving simulator study

Rural roads are characterized by a high percentage of run-off-the-road accidents and head-on collisions, mainly caused by inappropriate speeds and failure to maintain a proper lateral position along the roadway alignment. Among several road safety treatments, low-cost perceptual measures are considered an effective tool, as they generally increase the risk perceived by drivers, or even alter the drivers’ speed perception, and consequently tempting them to decrease their speeds. Their effectiveness has been widely recognized in a number of studies, especially with respect to road intersections and curves.The overall aim of this study is to investigate the effects of different perceptual treatments on driving speed, along a crest vertical curve of an existing two-lane rural road, in order to identify the most effective measure to reduce speed and define its subsequent implementation in the field. Three perceptual treatments were tested using a driving simulator: white peripheral transverse bars, red peripheral transverse bars and optical speed bars, with each one being painted along the approaching tangent to the crest vertical curve. The effects of these speed-reducing measures were investigated using a sample of forty-four participants, by comparing the driving speeds with those recorded under a baseline condition (without a treatment); these were also used to validate the driving simulator’s speed measurements with those found in the field. Moreover, subjective measures were collected, consisting of the driver’s static evaluation of the desired speed, risk perception and markings comprehension, based on screen shot pictures that represented the simulated configurations of the treatments.The findings demonstrated an overall effectiveness of the perceptual treatments, although only the red peripheral transverse bars were found to significantly reduce the driving speeds (−6 km/h). The analysis of the questionnaire yielded interesting information and demonstrated the importance of performing driving simulation tests for evaluating the effectiveness of perceptual treatments.Finally, the results confirmed the enormous potential of using driving simulators to pinpoint a number of speed-reducing measures, and consequently select the most effective one that reduces cost and promotes safety before its actual implementation in the field.     

Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl

The alpha-2 adrenergic receptor antagonist, yohimbine, can facilitate fear extinction in animals and humans. One potential mechanism is increased noradrenergic activity and associated arousal in the presence of conditioned stimuli. Accordingly, yohimbine might augment prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD), where heightened exposure-oriented arousal is a theorized driver and empirical predictor of treatment success. A double-blind placebo-controlled randomized trial (NCT 01031979) piloted yohimbine augmentation in 26 males with combat-related PTSD. Participants were given one-time dose of yohimbine or placebo prior to the first imaginal exposure. Subsequently, both arms completed standard PE. The primary outcome was trauma-cued heart-rate reactivity a week after the drug/exposure visit, a highly specified, objective measure sensitive to incremental change. Secondary outcomes included arousal during the drug/exposure visit and slope of distress, PTSD, and depression over the course of PE. Consistent with hypothesis, yohimbine led to higher objective and subjective arousal during the drug/exposure visit and to lower trauma-cued heart-rate reactivity one-week later. One dose of yohimbine also led to greater between-session habituation and more rapid improvement on depression, but not PTSD, over the course of care. Results of this controlled pilot indicate support for continued investigation of yohimbine-augmented exposure therapy for PTSD.