Blended courage: Moral and psychological courage elements in mental health treatment seeking by active duty military personnel

We propose that seeking mental health care in an environment with heightened stigma may combine elements of both psychological and moral courage. Interviews of 32 active duty US Army personnel about their process of seeking current mental health care were analyzed for themes of voluntary action, personal risk, and noble or worthwhile goals (benefits). Risks and benefits were divided into internal risks and benefits, characteristic of psychological courage; and external risks and benefits, characteristic of moral courage. Concerns about external risks were themes in all narratives, while concerns about internal risks were themes in only about half of narratives. Both internal and external benefits of treatment were themes in approximately three-quarters of the narratives, whereas doubts about internal (but not external) benefits were also expressed at a similar rate. Thus, participants described an act of blended courage, with social risks of moral courage taken for wellness goals of psychological courage.     

A Single-Subject Evaluation of the Treatment of Morphing Fear

We present a single-subject prospective outcome study of a man with severe morphing fear and long history of OCD who was not helped by previous interventions, and who received an adapted form of cognitive behavior therapy (CBT) as part of this study. Treatment consisted of a cognitively focused approach tailored to address his fear of morphing and included developing a stronger sense of self-stability. We describe the details of the case, the treatment protocol, and the therapeutic outcomes as assessed over 36 weeks by questionnaires, rating scales, and semistructured interviews. The intervention was effective in eradicating the patient’s morphing fears and reducing other symptoms of OCD, anxiety, and depression. The presented case illustrates the need to appropriately conceptualize, assess, and address the specific nature of morphing fear symptoms in treatment.     

Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration

Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) entails regular intravitreal anti-vascular endothelial growth factor (VEGF) injections, often indefinitely. Little is known about the burden imposed on patients by this repetitive treatment schedule and how this can be best managed. The aim of this study was to explore the psychosocial impact of repeated intravitreal injections on patients with neovascular AMD. Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited using purposive sampling from a private ophthalmology practice and public hospital in Melbourne. Patients were surveyed using the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ; Bradley, Health Psychology Research Unit, Surrey, England) and underwent semi-structured, one-on-one interviews. Interview topics were: treatment burden and satisfaction; tolerability; barriers to adherence; treatment motivation; and patient education. Interviews were audio recorded and thematic analysis performed using NVivo 10 (QSR International, Doncaster, Australia). Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule. Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers. Many patients were restricted to sedentary activities post-injection owing to treatment side effects. Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received. Whilst anti-VEGF injections represent the current mainstay of treatment for neovascular AMD, the ongoing treatment protocol imposes significant burden on patients. An understanding of the factors that contribute to the burden of treatment may help inform strategies to lessen its impact and assist patients to better manage the challenges of treatment.     

Effects of perception on public bike-and-ride: A survey under complex,multifactor mode-choice scenarios

Bicycles are an environmentally-friendly, energy-saving mode of transportation. Public bike-and-ride is a term used to describe the use of public bicycles combined with transit as a means of transportation. A new stated preference (SP) design scheme based on the factors respondents felt were most important was proposed to augment the traditional SP design under complex multi-factor and multi-level situations. iPads were used to automatically administer the survey under each design scheme and collect the choice behavior data for public bike-and-ride. The concept of perceived psychological distance was further proposed and used to estimate Logit models. Comparative analysis of these models shows for the traditional SP design scheme, some factors, including perceived psychological distance, have reduced statistically significant effects on public bike-and-ride choice relative to the new SP design scheme. This indicates that in scenarios with complex decisions, the decision-makers would reduce their consideration of some factors and simplify their decision process making the new SP survey design scheme more suitable to analyze their choice behavior in those cases. Model analysis showed that perceived psychological distance for each traveler is the most critical factor during the decision process for travel behavior analysis. Finally, sensitivity analysis was conducted to determine which factors in the new survey design were important to increase the share of public bike-and-ride users. Practical findings for promoting public bike-and-ride use are presented in addition to theoretical references for improving the traditional survey methods.     

An Evaluation of the Word Triad Method for Monitoring Spelling Progress

Although spelling skill progress has typically been studied within the context of students' responses to written story starters (Deno, Marsten, & Mirkin, 1982; Fuchs & Fuchs, 2011; Hosp, Hosp, & Howell, 2007; Shinn & Shinn, 2002), there has been little research conducted within a curriculum-based measurement framework that has studied spelling progress monitoring on a weekly basis throughout an entire school year. The authors evaluated spelling progress using word triads, defined as a group of 3 words (with the same number of letters) that have a similar phonetic or morphological structure. Successful spelling of word triads as the unit of analysis has the potential to be more useful diagnostically to teachers than successful spelling of single words as the unit of analysis. An alternating series of three 15-word spelling tests were administered weekly to 10 third- and fourth-grade classrooms in the same school district throughout the school year for 8 rounds (1 round = 3 weeks of different but phonetically and/or morphologically similar word lists). Results indicate steady progress throughout the school year in the correct spelling of word triads (despite teacher reporting of no explicit spelling instruction in classrooms using in the words employed in the study). Correlations between the number of correctly spelled word triads with standard scores from a group-administered communication arts test were significant and comparable to alternate spelling test scoring methods. The authors conclude with limitations of the study and implications for practitioners.     

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.     

The Mistreatment of My People: Victimization by Proxy and Behavioral Intentions to Commit Violence Among Muslims in Denmark

Islamist extremism is often explained by the suffering endured by Muslims in Islamic countries as a result of Western‐led wars. However, many terrorist attacks have been carried out by European Muslims with no personal experiences of war. Across two studies among Danish Muslims, we tested if what we call “victimization‐by‐proxy processes” motivate behavioral intentions to commit acts of violence. We used Muslim identification, perceived injustice of Western foreign policies, and group‐based anger to predict violent and nonviolent behavioral intentions. More importantly, we compared path models of Danish Muslims from conflict zones with those without direct personal experience of Western‐led occupation. We found similar effects among the participants in each category, that is, vicarious psychological responses mimicked those of personally experienced adversity. In fact, participants born in Western Europe were, on average, more strongly identified with Muslims, more likely to perceive Western foreign policy as more unjust, reported greater group‐based anger, and were more inclined to help Muslims both by nonviolent and violent means.     

Agents of Prosociality: Agency Affirmation Promotes Mutual Prosocial Tendencies and Behavior Among Conflicting Groups

Members of conflicting groups are motivated to restore their ingroup's agency, leading to antisocial tendencies against the outgroup. The present research tested the hypothesis that affirming conflicting groups' agency would increase their members' mutual prosociality. The effectiveness of agency affirmation was demonstrated in three contexts of conflict between groups: Switzerland and the EU following the 2014 referendum (Study 1), Israelis and Palestinians (Study 2), and Israeli rightists and leftists (Study 3). Study 1 found that in a nonconflictual context Swiss participants prioritized their moral (prosocial) over agentic goals, yet in the context of conflict with the EU, they prioritized their agentic over moral goals. This “primacy‐of‐agency” effect, however, was eliminated once their ingroup's agency was affirmed. Studies 2 and 3 demonstrated the positive effect of agency affirmation on prosociality among Israelis referring to Palestinians and Israeli rightists and leftists referring to the adversarial political camp. This effect was mediated by group members' readiness to relinquish some power for the sake of morality. Pointing to the importance of the affirmation's specific content, Studies 2 and 3 demonstrated that morality affirmation failed to increase prosociality. As such, the present research puts forward a promising strategy to reduce hostility and promote prosociality between conflicting groups.     

Sexual‐perception processes in acquaintance‐targeted sexual aggression

This study analyzes data from seven published studies to examine whether three performance‐based indices of men's misperception of women's sexual interest (MSI), derived from a self‐report questionnaire, are associated with sexual‐aggression history, rape‐supportive attitudes, sociosexuality, problem drinking, and self‐reported MSI. Almost 2000 undergraduate men judged the justifiability of a man's increasingly unwanted advances toward a woman on the Heterosocial Perception Survey‐Revised. Participants self‐reported any sexual‐aggression history, and some completed questionnaires assessing rape‐supportive attitudes, sociosexuality, problem drinking, and self‐reported MSI. A three‐parameter logistic function was fitted to participants’ justifiability ratings within a non‐linear mixed‐effects framework, which provided precise participant‐specific estimates of three sexual‐perception processes (baseline justifiability, bias, and sensitivity). Sexual‐aggression history and rape‐supportive attitudes predicted: (a) reduced sensitivity to women's affect; (b) more liberal biases, such that the woman's affect had to be more negative before justifiability ratings dropped substantially; and (c) greater baseline justifiability of continued advances after a positive response. Sexual‐aggression history and attitudes correlated more strongly with sensitivity than baseline justifiability; remaining variables showed the opposite pattern. This work underscores the role of sexual‐perception processes in sexual aggression and illustrates the derivation of performance‐based estimates of sexual‐perception processes from questionnaire responses.