Depersonalisation disorder: a cognitive-behavioural conceptualisation

Depersonalisation (DP) and derealisation (DR) are subjective experiences of unreality in, respectively, one’s sense of self and the outside world. These experiences occur on a continuum from transient episodes that are frequently reported in healthy individuals under certain situational conditions to a chronic psychiatric disorder that causes considerable distress (depersonalisation disorder, DPD). Despite the relatively high rates of reporting these symptoms, little research has been conducted into psychological treatments for this disorder. We suggest that there is compelling evidence to link DPD with the anxiety disorders, particularly panic. This paper proposes that it is the catastrophic appraisal of the normally transient symptoms of DP/DR that results in the development of a chronic disorder. We suggest that if DP/DR symptoms are misinterpreted as indicative of severe mental illness or brain dysfunction, a vicious cycle of increasing anxiety and consequently increased DP/DR symptoms will result. Moreover, cognitive and behavioural responses to symptoms such as specific avoidances, ‘safety behaviours’ and cognitive biases serve to maintain the disorder by increasing awareness of the symptoms, heightening the perceived threat and preventing disconfirmation of the catastrophic misinterpretations. A coherent model facilitates the development of potentially effective cognitive and behavioural interventions.     

Genetic and environmental influences on individual differences in printed word recognition

The genetic and environmental etiologies of individual differences in printed word recognition and related skills were explored in 440 identical and fraternal twin pairs between 8 and 18 years of age. A theoretically driven measurement model identified five latent variables: IQ, phoneme awareness, word recognition, phonological decoding, and orthographic coding. Cholesky decomposition models on these five latent constructs revealed the existence of both common and independent genetic effects, as well as non-shared environmental influences. There was evidence for moderate genetic influences common between IQ, phoneme awareness, and word-reading skills, and for stronger IQ-independent genetic influences that were common between phoneme awareness and word-reading skills, particularly phonological decoding. Phonological and orthographic coding skills in word recognition had both significant common and significant independent genetic influences, with implications for "dual-route" and "connectionist" reading models, subtypes of reading disabilities, and the remediation of reading disabilities.     

Gene therapy: ethical issues

To discern the ethical issues involved incurrent gene therapy research, to explore theproblems inherent in possible future genetherapies, and to encourage debate within thescientific community about ethical questionsrelevant to both, we surveyed American Societyof Human Genetics scientists who engage inhuman genetics research. This study of theopinions of U.S. scientific experts about theethical issues discussed in the literature ongene therapy contributes systematic data on theattitudes of those working in the field as wellas elaborative comments. Our survey finds thatrespondents are highly supportive of thepotential use of somatic cell gene therapy tocure serious diseases in adults and children aswell as prospective offspring. A clearmajority, however, believe that using suchgenetic techniques for enhancement purposes isunacceptable. Delineating the line betweendisease/disorder and improvement/enhancementposes a problem not easily resolved and oneconducive to the growth of slippery-slopeapprehensions. The majority of respondents alsoadvocate germ-line therapy, in theory at least,and under similar restrictions, but theyrecognize the roadblock that the existence ofunanticipated negative consequences currentlypresents. Another complex matter involvestrying to determine appropriate reasons forchoosing target diseases for research, forwhich the dichotomy between rare single-geneand common multifactorial diseases reveals anongoing dilemma.     

Progressing from programmatic to discovery research: a case example with the overjustification effect

Scientific research progresses along planned (programmatic research) and unplanned (discovery research) paths. In the current investigation, we attempted to conduct a single-case evaluation of the overjustification effect (i.e., programmatic research). Results of the initial analysis were contrary to the overjustification hypothesis in that removal of the reward contingency produced an increase in responding. Based on this unexpected finding, we conducted subsequent analyses to further evaluate the mechanisms underlying these results (i.e., discovery research). Results of the additional analyses suggested that the reward contingency functioned as punishment (because the participant preferred the task to the rewards) and that withdrawal of the contingency produced punishment contrast.     

Teaching safety skills to children to prevent gun play

Research has shown that children often engage in gun play when they find a firearm and that this behavior is often involved in unintentional firearm injuries. Previous research has shown existing programs to be ineffective for teaching children safety skills to reduce gun play. This study examined the effectiveness of a behavioral skills training (BST) program supplemented with in situ training for teaching children safety skills to use when they find a gun (i.e., don't touch, leave the area, tell an adult). Eight 4- to 5-year-old children were trained and assessed in a naturalistic setting and in a generalized setting in a multiple baseline across subjects design. Results showed that 3 of the children performed the skills after receiving BST, whereas 5 of the children required supplemental in situ training. All children in the study learned to perform the skills when assessed in a naturalistic setting and when assessed in a generalization setting. Performance was maintained at 2- to 8-week follow-up assessments.     

Response-independent milk delivery enhances persistence of pellet-reinforced lever pressing by rats

If, during training, one stimulus is correlated with a higher rate of reinforcement than another, responding will be more resistant to extinction in the presence of that higher rate signal, even if many of the reinforcers have been presented independently of responding. For the present study we asked if the response-independent reinforcers must be the same as the response-dependent reinforcers to enhance the response's persistence. Twelve Long-Evans hooded rats obtained 45-mg food pellets by lever pressing (variable-interval 100-s schedules) in the presence of two discriminative stimuli (blinking vs. steady lights) that alternated every minute during daily sessions. Also, in the presence of one of the stimuli (counterbalanced across rats), the rats received additional response-independent deliveries of sweetened condensed milk (a variable-time schedule). Extinction sessions were exactly like training sessions except that neither pellets nor milk were presented. Lever pressing was more resistant to extinction in the presence of the milk-correlated stimulus when (a) the size of the milk deliveries during training (under a variable-time 30 s schedule) was 0.04 ml (vs. 0.01 ml) and (b) 120-s or 240-s blackouts separated components. Response-independent reinforcers do not have to be the same as the response-dependent reinforcers to enhance persistence.     

认知行为疗法在儿童社会退缩行为干预中的新进展

社会退缩行为指儿童在社会情境中抑制自己参与同伴互动并表现出独处的行为。社会退缩阻碍儿童形成良好的社交能力,影响其人格和认知的健康发展,因而对儿童社会退缩行为进行及时干预显得十分重要。研究对认知行为疗法在儿童社会退缩行为干预中的进展进行了整合,包括虚拟现实暴露疗法、学校情境下的认知行为治疗及网络认知行为治疗。未来研究应设计针对社会退缩行为不同亚类型的干预方案,以及在干预中重视情绪调节的训练和教师的介入。     

Cognitive Barriers to Successful Weight Management: 7 Stymie Beasts

This paper focuses on one of the most significant barriers, especially for teenagers and their families, to the effectiveness of cognitive behavioral therapy (CBT) for weight management: high rates of attrition. Cognitive barriers contribute to attrition and to decreasing commitment to full engagement in the process (deliberate practice). Excuses capture the essence of one type of those cognitive barriers. Excuses are defined as shifts in attribution from self-focused causes of struggles to achieve goals to more externally-focused causes—resulting in decreasing full engagement. Those excuses (shifts in attribution) do not just happen. People make decisions to implement those shifts away from personal responsibility. Ten cognitive biases lie at the heart of such problematic delusional decision making. This paper identifies seven excuses created by that biased decision making as anthropomorphisms called Stymie Beasts. Such unique simply worded visually distinctive creatures may help improve recall and focus on these powerful antagonists to successful weight control. Then, the use of two CBT techniques, Therapeutic Understanding of Science (TUS) and Rational Emotive Therapy (RET), illustrated with examples for all seven Stymie Beasts, shows how CBT may prevent and dismantle those Beasts (excuses). Ideas for future research using randomized controlled trials to test these notions are also presented.     

Adaptations of an Integrated Behavioral Health Program During COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has consistently been described as an “unprecedented” global health crisis. While the focus has been primarily on the medical and economic impact of the pandemic, psychological sequelae are anticipated. Primary care is the main point of access for mental health care in the United States, making it the ideal locale to provide psychological services for a larger proportion of the population than traditional mental health care settings. The aim of this paper is to describe how our multi-state, multi-site integrated primary care program adapted and applied cognitive behavioral therapy in the context of COVID-19. Access to mental health care was disrupted despite burgeoning mental health concerns, necessitating novel approaches to providing care. A stepped-care approach was implemented within our primary care practice, which consisted of a combination of low-intensity, high-yield stress management and resiliency building resources and cognitive behavioral therapy that were delivered flexibly based on patient preference, technological capabilities, state ordinances, insurance coverage, and institutional policies. The lessons learned from this experience can inform other integrated primary care clinics in responding to the current and future pandemics.     

Using behavioral skills training with preservice teachers in the university classroom

Preservice and novice teachers often identify behavior management as an area of weakness that they attribute to a lack of sufficient instruction during their teacher preparation. Behavioral skills training (BST) is an evidence‐based teaching methodology based on the principles of applied behavior analysis used to teach new skills. This study investigated the use of BST in the university setting to teach undergraduate preservice teachers enrolled in a field‐based special education course to implement a token economy during small group instruction with children. A single‐case research design was used to assess the effectiveness of using BST by evaluating accuracy of implementation before and after BST. Results showed BST was an effective teaching procedure and social validity measures collected from the preservice teachers indicated BST was acceptable to all participants. Limitations and needs for future research are discussed.