Neuropsychological functioning in kleptomania

Kleptomania is characterized by the failure to resist impulses to steal objects not needed for personal use or their monetary value. The objective of this study was to examine cognitive and executive functioning in subjects with kleptomania. Fifteen women with a primary DSM-IV diagnosis of kleptomania underwent a detailed psychiatric examination, including measures of kleptomania severity, and a battery of neuropsychological tests that emphasized executive functions. Correlational analyses were computed between measures of kleptomania severity and tests of executive functioning. Kleptomania subjects reported a mean duration of illness of 17.9 years and shoplifting a mean of 1.7 times per week. All subjects reported an inability to resist urges to shoplift. Neuropsychological testing revealed group mean test scores within 0.5 standard deviations of normative standards for age. Five subjects (33.3%), however, had below-average performance on at least one measure of executive functioning, and 4 (26.7%) had below-average scores on two executive measures. Correlational analyses revealed a statistically significant correlation between kleptomania severity and Wisconsin Card Sorting Test performance (r=-0.693, p=0.004). As a group, subjects with kleptomania did not demonstrate deficits on neuropsychological testing. Greater kleptomania symptom severity, however, was correlated with impairment in executive functioning.     

Guided self-help versus pure self-help for perfectionism: a randomised controlled trial

Perfectionism is known to be a risk factor for the development and maintenance of obsessive-compulsive (OC) and depressive symptoms. The purpose of the present study was to test the effectiveness of a cognitive-behavioural self-help therapy for perfectionism, and to examine the effect of such treatment on OC and depressive symptomatology. The study compares the effectiveness of guided self-help (GSH, n=24) with pure self-help (PSH, n=25) therapy. Both GSH and PSH were found to be effective in reducing perfectionism, and also in reducing OC and depressive symptomatology. Overall, participants in the GSH condition experienced greater symptom improvement than participants in the PSH condition, and treatment gains for both groups were largely maintained at 3-month follow-up. Twenty percent of PSH participants experienced clinically significant increases in depressive symptoms over the treatment and follow-up period (compared to 0% in the GSH condition), suggesting that PSH may be a less suitable strategy than GSH in treating this population. Overall, the findings suggest that self-help for perfectionism is effective in reducing OC and depressive symptomatology in non-clinical individuals, with GSH being superior to PSH.     

The role of attentional biases in PTSD: is it interference or facilitation?

Although attentional biases have been demonstrated in individuals with posttraumatic stress disorder (PTSD), the cognitive methodologies used have not allowed for disambiguation of two types of attentional biases. It remains unclear if PTSD involves difficulty disengaging attention from threatening stimuli (interference) or facilitated detection. To differentiate between attentional interference and facilitation, 57 male Vietnam-era veterans (30 High PTSD and 27 Low PTSD) completed a visual search task with a lexical decision component. High PTSD veterans who engaged in the interference task first showed increased interference to threat-relevant words relative to Low PTSD veterans. However, no evidence was found for facilitated detection of threatening stimuli in PTSD.     

Mechanisms of change in ERP treatment of compulsive hand washing: does primary threat make a difference?

The present study sought to examine patterns of habituation in exposure and response prevention (ERP) treatment of compulsive hand washing. Sub-clinical compulsive washers (n=27) with illness or non-illness primary threats were compared in order to detect potential differences in response to a single session of ERP. Changes in anxiety, disgust, and urge to wash were analyzed, and significant reductions in both anxiety and disgust were noted. Urge to wash significantly declined among washers primarily concerned with illness; among those concerned with non-illness threats, urge to wash did not significantly decline. Moreover, anxiety was found to decline when controlling for disgust and vice versa. Lastly, when both anxiety and disgust were entered into a model predicting changes in urge to wash, anxiety but not disgust predicted urge to wash for those with illness-related threats; for washers with non-illness threats, the findings were the reverse. Several clinical and theoretical implications are discussed.     

Effects of live exposure on symptoms of posttraumatic stress disorder: the role of reduced behavioral avoidance in improvement

Although the effectiveness of cognitive-behavioral treatment in posttraumatic stress disorder (PTSD) is well established, few studies examined its effects on individual PTSD symptoms and possible mechanisms of improvement in symptoms. In a previous randomized controlled study [Ba?og lu, M., Salciog lu, E., Livanou, M., Kalender, D., & Acar, G. (2005). Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: A randomized waitlist controlled trial. Journal of Traumatic Stress, 18, 1-11] a single session of behavioral treatment involving self-exposure instructions was highly effective in reducing earthquake-related PTSD. In the present study we examined the effects of treatment on each PTSD symptom and which symptoms improved early in treatment. Because the intervention focused solely on behavioral avoidance, we hypothesized that avoidance would be the first symptom to change and that reduction in avoidance would generalize to all other symptoms. The results showed significant between-groups treatment effect on only behavioral avoidance early in treatment (week 6). At 6 months post-treatment recovery rates ranged from 60% to 89% for 15 PTSD symptoms, including the numbing symptoms. Lack of improvement in avoidance was associated with lack of improvement in 12 symptoms. The critical process in recovery thus appeared to be increased sense of control associated with reduction in avoidance. These findings imply that live exposure to fear cues designed to enhance sense of control might be sufficient for recovery from PTSD.     

A prospective study of appraisals in childhood posttraumatic stress disorder

This study investigated the predictors of posttraumatic stress disorder (PTSD) in children following a diagnosis of traumatic injury. Children (N=76) aged between 7 and 13 who were admitted to hospital following injury were assessed within a month of trauma for acute stress disorder (ASD), negative appraisals, as well as parental stress reactions. Children (N=62) were re-assessed 6-months later for PTSD and negative appraisals. The majority of the variance of chronic posttraumatic stress was accounted for by negative appraisals about future harm. This study supports cognitive models of PTSD, and suggests that younger children who exaggerate their vulnerability after trauma exposure are high risk for PTSD after trauma.     

Fear conditioning in posttraumatic stress disorder: evidence for delayed extinction of autonomic, experiential, and behavioural responses

Aversive conditioning has been proposed as an important factor involved in the etiology of posttraumatic stress disorder (PTSD). However, it is not yet fully understood exactly which learning mechanisms are characteristic for PTSD. PTSD patients (n=36), and healthy individuals with and without trauma exposure (TE group, n=21; nTE group, n=34), underwent a differential fear conditioning experiment consisting of habituation, acquisition, and extinction phases. An electrical stimulus served as the unconditioned stimulus (US), and two neutral pictures as conditioned stimuli (CS+, paired; CS-, unpaired). Conditioned responses were quantified by skin conductance responses (SCRs), subjective ratings of CS valence and US-expectancy, and a behavioural test. In contrast to the nTE group, PTSD patients showed delayed extinction of SCRs to the CS+. Online ratings of valence and US-expectancy as well as the behavioural test confirmed this pattern. These findings point to a deficit in extinction learning and highlight the role of affective valence appraisals and cognitive biases in PTSD. In addition, there was some evidence that a subgroup of PTSD patients had difficulties in learning the CS-US contingency, thereby providing preliminary evidence of reduced discrimination learning.     

Intrusive images in PTSD and in traumatised and non-traumatised depressed patients: a cross-sectional clinical study

Although intrusive images are a hallmark of post-traumatic stress disorder (PTSD) and also occur in depression, little is known about the differences and similarities of such images in these conditions. Our study focuses on the qualities and triggers of intrusive images and responses to them in three groups--patients with PTSD, and depressed patients with and without trauma (n=65)-to highlight the diagnostic specificity of intrusive images for PTSD and depression. We distinguished intrusive images from verbal intrusive cognitions such as rumination and intrusive (brief) lexical thoughts. Consistent with the literature, the intrusive images of PTSD patients had a more "here-and-now quality" and were perceived more visually compared to those of both depressed groups. The groups showed a good deal of similarity concerning other image qualities. Most importantly, the intrusive images in PTSD and depressed patients with and without trauma were perceived as similarly distressing. Rumination and intrusive (brief) lexical thoughts were two of the five most named triggers of intrusive images. Limitations, such as the lack of a control group, and the clinical implications of these results are discussed, demonstrating the need to help non-PTSD patients with and without trauma to deal with intrusive images.     

Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: an analog to obsessive-compulsive disorder

Cognitive-behavioral models of obsessive-compulsive disorder (OCD) assume that obsessions have their origin in normal intrusive thoughts. These models propose that certain beliefs, such as thought-action fusion (TAF) beliefs, combined with the use of ineffective coping strategies, such as thought suppression, lead to the development of OCD. The purpose of the current study was to examine the relationship between these variables in a non-clinical sample in addition to exploring the effects of an alternative, acceptance-based coping strategy. This study explored the relationship between TAF beliefs, thought suppression, and OC-consistent symptoms via mediational analyses. Results showed that thought suppression mediated the relationship between TAF beliefs and OC-consistent symptoms. This study also experimentally examined the effects of various coping strategies (suppression, acceptance, or monitor-only) on the frequency of a distressing intrusion and appraisal ratings (e.g., anxiety, guilt, responsibility) after a TAF induction. Spontaneous suppression in the monitor-only group made comparisons of the experimental data difficult. However, analyses provided preliminary evidence suggesting that thought suppression is related to more intrusions, higher levels of anxiety, and negative appraisals, whereas an acceptance-based approach may be a useful alternative. Additional findings, limitations of the current study, and directions for future research are discussed.     

Dyadic predictors of outcome in a cognitive-behavioral program for patients with generalized anxiety disorder in committed relationships: a "spoonful of sugar" and a dose of non-hostile criticism may help

The present study tested whether pre-treatment levels of partner hostility and non-hostile criticism predicted outcome in an individual cognitive-behavioral therapy package for generalized anxiety disorder (GAD). Eighteen patients with a principal or co-principal diagnosis of GAD were randomly allocated to a treatment condition (n=8) or a delayed treatment condition (n=10). In addition, the patients and their partners were videotaped discussing the patients’ worries. These videotapes were later coded for levels of partner hostility and non-hostile criticism directed at the patients. Treatment resulted in statistically and clinically significant change at post-test. Finally, partner hostility predicted worse end-state functioning whereas partner non-hostile criticism predicted better end-state functioning.