Post-Admission Cognitive Therapy for a Transgender Service Member With a Recent Suicidal Crisis: A Case Study of Gender-Affirming Care

While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) Service members requires that interventions address suicide risk within the context of minority stressors and gender-affirming care. This case study presents Jordan (an alias), a transgender Service member who received inpatient psychiatric treatment following a suicide attempt precipitated by distress relating to gender dysphoria, minority status, and associated stressors. Jordan completed Post-Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway, Cox, & Greene, 2012), a cognitive-behavioral intervention targeting suicide risk among military personnel and dependents psychiatrically hospitalized following a suicidal crisis. Within the context of PACT, Jordan’s treatment included identifying and addressing distress related to minority stressors (externalized stigma, internalized transphobia, anticipated rejection, gender concealment) using gender-affirming best practices. Marked changes in Jordan's self-report measures from baseline to follow-up, as well as qualitative changes reported by Jordan, demonstrate that she felt comfortable, safe, and ready to be discharged from the inpatient unit after completing PACT treatment and gaining exposure to the skills necessary to help prevent and/or manage future suicidal crises. Treatment implications and recommendations for addressing suicide risk within the context of gender-affirming care and prevalent minority stressors are discussed.     

Race in the Space: Clinical Considerations for Addressing Race in Treatment

During a period of intense racial unrest in the nation, we were working as clinicians delivering a manualized protocol to LGBTQ adults of varying racial and ethnic backgrounds. Intrigued by the differences in our modes of engagement with clients, we, a Black, cis female therapist and White, cis male therapist, set out to further explore how our positionalities informed our communications with, and expectations of, White and non-White clients during this time. In this paper, we reflect on these differences when delivering therapy in cross-racial and same-race dyads. We highlight where our experiences overlap as clinicians trained in the same program and where they diverge due to our respective worldviews. We conclude with considerations for practitioners to engage with race in psychotherapeutic treatment.     

On the longevity of behavioral interventions for challenging behavior

The capacity for a treatment to maintain its effects over time may be the most critical component of behavioral interventions for challenging behavior as treatments that fail to persist are likely to be of little value to society. We reviewed the quality and quantity of different types of post-intervention data for the treatment of challenging behavior in studies published over the last 7 years. We found that for the majority of participants at least one measure of maintenance, fading, or follow-up was reported but with limited information regarding the quality of those measures. Reports of secondary variables related to post-intervention data (e.g., latency to measurement) were also uncommon. We discuss possible explanations for the paucity of post-intervention data, barriers to obtaining post-intervention data, strategies for obtaining these data, and implications for the external validity of behavioral interventions for challenging behavior. We provide recommendations for increasing the probability that post-intervention data are included in applied research on challenging behavior.     

The role of effort type and intensity in children's decisions about effort-based outcomes

Despite the importance of persistence in early learning, we know little about how children reason about outcomes that result from their efforts. Here we examined the role of effort type (i.e., physical vs. cognitive) and intensity (i.e., high vs. low effort) in shaping children's decision making about effort-based rewards. Five- to 7-year-olds (N = 133) were assigned to one of four conditions (High Physical Effort, Low Physical Effort, High Cognitive Effort, Low Cognitive Effort) and completed a series of tasks to construct a toy. Tasks varied in the type (physical/cognitive) and intensity (high/low) of effort required to complete them. After constructing their toy, children completed a series of tasks to probe how much they valued that toy. Across conditions, children preferred their toy and gave it a higher monetary value, relative to a stranger's. However, when choosing their toy came at a cost, children no longer preferred it. Only children who built their toy through either cognitive or low effort were willing to incur a cost for their toy. Older children, across conditions, were also more likely to incur a cost for their toy. These findings demonstrate that by age five, children are sensitive to variations in effort type and intensity, and these factors shape how they evaluate effort-based rewards.     

Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.     

Inoculation against conspiracy theories: A consumer side approach to India's fake news problem

We attempt to replicate Roozenbeek and van der Linden's Western-based study in India by employing the Bad News Game, an online game, in which players take on the role of a misinformation tycoon. They are exposed to weakened doses of the strategies employed in conspiracy and fake news production with the aim to cognitively inoculate them against misinformation. The proliferation of inexpensive mobile connections coupled with a lack of digital literacy has resulted in a conspiratorial pandemic in developing countries like India. We test the game's impact on an Indian sample (n = 1002) using a within-subject design. We provide evidence of significant improvement in the ability of participants to identify the misinformation produced using Conspiracy, Impersonation, and to a lesser extent, the Discrediting technique, while observing greater truth discernment in correctly identifying true news. We also conduct sub-sample analyses. These findings have positive implications for methods that protect users from malignant online content.     

Insights into computational thinking from think-aloud interviews: A systematic review

This systematic review examines 35 empirical studies featuring the use of think-aloud interviews in computational thinking (CT) research. Findings show that think-aloud interviews (1) are typically conducted in Computer Science classrooms and with K-12 students; (2) are usually combined with other exploratory CT assessment tools; (3) have the potential to benefit learners with special needs and identify the competency gaps through involving diverse participants; (4) are conducted in the absence of cognitive models and standard procedures; and (5) display insufficient definitional and methodological rigor. Theoretically, this review presents a systematic assessment about the application of think-aloud interviews in CT studies and identifies the limitations in existing CT-related think-aloud studies. Practically, this review serves as a reference for studying the cognitive processes during CT problem-solving and provides suggestions for CT researchers who intend to incorporate think-aloud interviews in their studies.     

Structural connectivity between the hippocampus and cortical/subcortical area relates to cognitive impairment in schizophrenia but not in mood disorders

Cognitive impairment in schizophrenia and other psychiatric disorders is a challenge to be overcome in order to maintain patients' quality of life and social function. The neurological pathogenesis of cognitive impairment requires further elucidation. In general, the hippocampus interacts between the cortical and subcortical areas for information processing and consolidation and has an important role in memory. We examined the relationship between structural connectivity of the hippocampus and cortical/subcortical areas and cognitive impairment in schizophrenia, major depressive disorder and bipolar disorder. Subjects comprised 21 healthy controls, 19 patients with schizophrenia, 20 patients with bipolar disorder and 18 patients with major depressive disorder. Diffusion-weighted tensor images data were processed using ProbtrackX2 to calculate the structural connectivity between the hippocampus and cortical/subcortical areas. Cognitive function was assessed using the Brief Assessment of Cognition in schizophrenia composite score. Hippocampal structural connectivity index was significantly correlated with composite score in the schizophrenia group but not in the healthy control, major depressive disorder or bipolar disorder groups. There were no statistically significant differences in hippocampal structural connectivity index between the four groups. Structural connectivity between the hippocampus and cortical/subcortical areas is suggested to be a pathophysiological mechanism of comprehensive cognitive impairment in schizophrenia.     

Cognitive habilitation in schizophrenia: A theoretical review and model of treatment

Evidence has accumulated for information processing deficits in schizophrenia. The functional significance of these deficits is only beginning to be understood. There are indications that these deficits may respond to intervention. Training on deficient functions has been demonstrated to relate to improvements in performance. A treatment program of cognitive rehabilitation is deduced from the literature and induced from clinical experience. The treatment is designed to impact directly on the information processing deficits of schizophrenic patients and indirectly to ameliorate functional deficits.