Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.     

精神病态暴力犯执行功能的缺陷*

为了解精神病态罪犯可能存在的执行功能缺陷及其是否受冲动性影响,研究采用精神病态检核表（PCL-R）筛选出30名精神病态组被试和30名非精神病态组被试,通过爱荷华赌博任务（IGT）和河内塔任务（TOH）对两组被试执行功能的特点进行分析,并结合冲动性量表（BIS-11）对其冲动性进行测量。研究发现精神病态组的冲动性显著高于控制组;精神病态组选择高风险的不利牌显著多于对照组,即对惩罚不敏感;精神病态组在河内塔任务中的错误次数及所消耗时间都显著高于控制组;冲动性水平与两任务得分均无显著相关。结果表明,精神病态暴力犯在与前额叶相关的执行功能上存在缺陷,并与个体的高冲动性无关。     

Portrait of the therapist as a shaman

What follows will show that an understanding of the nature and purpose of shamanism contains a number of insights that bring to light some important, but often obfuscated, aspects of Western therapeutic practices. the point of departure of the argument is the theory of shamanism developed by the inventor of structural anthropology: Claude Lévi-Strauss. It will be argued, in particular, that his theory of shamanism provides a key to the therapeutic action of symbols upon the body as well as to the broader social function of therapy in general.     

Orientations of psychotic activity in defensive pathological organizations

The author reviews some clinical experiences of the treatment of personality disordered patients suffering from internal domination of ego functioning by a defensive pathological organization. In particular, the function and purpose of perverse, sadistic attacks by the organization on the ego are considered and questions pertaining to technique are raised. It is suggested that different forms of sadistic, subjugating activity by pathological organizations may denote differences in intent borne of the type and severity of the psychopathology of the individual. Patients with severe narcissistic psychopathology for whom object contact has become associated with the arousal of intense psychotic anxieties seem more likely to be subjected to an invasive, annihilatory imperative by the pathological organization, the purpose of which appears to be to obliterate the experience of contact with any differentiated object, to avoid emotion and to use coercion to enforce a primitive identification by the ego with the psychotic organization in the mind. Certain patients with less severe narcissistic psychopathology, yet for whom object contact can also be associated with the arousal of psychotic anxieties due to intense or persistent conflict with the object, sometimes expressed as organized sadomasochistic clinging to a punishing and punished object (for example, in certain borderline or depressed patients) exhibit sadistic attacks that serve less to annihilate object contact and more to intrusively control and punish the object. Observations of these phenomena have been made by a number of psychoanalysts in recent decades and these contributions are discussed. This paper is addressed primarily to the implications for technique with such patients, particularly a need for triangulation of their experiences of oppression in order to loosen the controls over the ego by the pathological organization.     

Feedback related brain activity in a gambling task: A temporal analysis of EEG correlates

Lucchiari, C. & Pravettoni, G. (2010). Feedback related brain activity in a gambling task: A temporal analysis of EEG correlates. Scandinavian Journal of Psychology 51, 449–454. The pattern of neural correlates of feedback processing has been the subject of a number of studies, using both neuroimaging and electrophysiological recordings. A complex functional network was found to be activated after a choice in order to process a feedback and sustain an adaptive behavior. However, many aspects of this network are still unclear and further research is needed to better understand this process. We conducted an EEG study using a simple gambling task. Twenty three subjects participated to the study. We analyzed both EEG power spectrum and ERP components evoked by presentation of a feedback signal (money gain or loss) during a simple gambling task. Our data confirmed that a negative ERP component is present about 270 ms after feedback, particularly relevant following a choice with negative outcome. Furthermore, the theta and delta oscillatory activity seem to be correlated to a dynamic decision‐making process within specific cortical networks. In particular, theta activity showed a valence dependent development between 150 and 350 ms post‐feedback onset. Differently from previous studies (Cohen, Elger & Ranganath, 2007; Marco‐Pallares, Cucurell, Cunillera et al., 2008), we did not find any valence effect in beta range. However, our data are consistent with Christie and Tata (2009) , probably due to the nature of the gambling task used in both studies. In conclusion, our data, in line with some prior findings showed that the feedback related response is correlated to a complex pattern of cortical activation probably mediated by theta and delta activity.     

Worry and Pathological Worry in Patients with Psoriasis: Cross Sectional and Longitudinal Analyses of the Penn State Worry Questionnaire (PSWQ) in Four Samples of Patients

The purpose of the present study was to examine the psychometric properties of the Penn state Worry Questionnaire (PSWQ) in patients with psoriasis. A series of cross-sectional and longitudinal studies were undertaken to assess the reliability, stability and validity of the measure. Patients with psoriasis from four samples (consecutive attendees, anxious patients, depressed patients, and 6-month follow-up of consecutive attendees) completed the PSWQ and measures assessing related constructs of anxiety and depression (HADS) and coping (COPE). The clinical severity of patients psoriasis was also assessed by dermatologists using the Psoriasis Area and Severity Index (PASI). Exploratory factor analysis was undertaken and receiver operator characteristic (ROC) analyses were used to examine the clinical utility of the PSWQ cut-off score for normal and pathological worry. Exploratory factor analysis suggested that the PSWQ is essentially unidimensional in patients with psoriasis. Intraclass correlation demonstrated that, over a 6-month period, the reproducibility of the PSWQ total scale was good in patients with anxiety and moderate in patients with depression. ROC analysis suggested that the optimum cutoff differentiating pathological worry was > 60, which is commensurate with findings in adult mental health more generally. The PSWQ cutoff for pathological worry showed a lower specificity for depression than anxiety. The PSWQ is an appropriate measure of pathological worry in patients with psoriasis. The cutoff on the scale for pathological worry demonstrates appropriate conceptual overlap with subordinate distress categories of anxiety and depression.     

Adolescent gambling and drug use

In this study, 4516 adolescents (aged 11–16 years) completed a questionnaire examining the relationship between underage National Lottery gambling, underage scratchcard gambling, cigarette smoking, drinking alcohol and drug use. It was found that these behaviours were closely linked. Adolescent gamblers reported that they were significantly more likely to drink alcohol (particularly ‘alcopops’), smoke tobacco and take drugs compared to non-gamblers. © 1998 John Wiley & Sons, Ltd.     

奖惩频率对3～5岁幼儿完成博弈任务的影响

通过对情感决策的常用研究工具——标准爱荷华博弈任务进行了得失总量不变而频率改变的修改,并使之适合于年幼的3～5岁儿童,可以比较幼儿在不同奖惩频率任务中的表现,从而考察奖惩频率对幼儿情感决策的影响。对120名3～5岁幼儿在四种不同类型的任务中的表现进行分析后,所得实验结果如下:(1)儿童对惩罚和奖励频率的变化比较敏感:正向博弈任务中,"有利纸牌不变,不利纸牌的惩罚总量不变,只增加不利纸牌的惩罚频率"可以使3～5岁儿童完成博弈任务的成绩有显著提高;逆向博弈任务中,"不利纸牌不变,有利纸牌的奖惩总量不变,而有利纸牌奖励频率的增加"能促使4～5岁幼儿更多更快地做出正确选择。(2)幼儿的情感决策能力在3～4岁时期发展迅速,而在4～5岁时仍然有较快发展。     

Risky decision making and cognitive flexibility among online sports bettors in Nigeria

Online sports betting is a popular recreational activity in Nigeria. Like other forms of gambling, risk of pathological progression exists for gamblers who continue betting despite severe financial and psychosocial consequences. In the present study, we examined whether this population of gamblers shows deficits in decision making and cognitive flexibility that have been documented in Western gambling populations. Thirty-six online sports bettors and 42 non-gambling participants completed a version of the Iowa gambling task (IGT) and an established set-shifting task for the assessment of cognitive flexibility. The two groups did not differ significantly in the selection of disadvantageous decks on the IGT. In contrast, sports bettors committed significantly more errors on the set-shifting task than non-gambling control participants. As this performance deficit was not specific to trials requiring a set shift, it most likely resulted from gambling-related changes in general cognitive or motivational abilities that are required to successfully complete challenging mental tasks. While our results illustrate that findings from Western populations cannot automatically be generalised to other contexts, it should be noted that we focused on only one particular type of gambling and included mostly participants with mild gambling-related problems.     

The Impact of Addictive Behaviors on Adolescents Psychological Well-Being: The Mediating Effect of Perceived Peer Support

Abstract

Studies exploring excessive Internet use and gambling are rapidly expanding concerns regarding its impact on mental health, especially in young people due to the increased prevalence of Internet and gambling addictions. Research suggests that perceived peer support plays a significant role in adolescents’ psychological well-being. However, no empirical study has dealt with the mediating effect of perceived peer support on the relationship between Internet and gambling addictions and psychological well-being. Thus, the present study aimed to examine whether perceived peer support mediates the relation between Internet and gambling addictions and psychological well-being of adolescents. A sample of 347 Iranian adolescents aged 14 to 18 (Mean age 16.14, 50.4% male) who were studying in Kuala Lumpur, Malaysia participated in this study. Subjective Vitality Scale (SVS), Compulsive Internet Use Scale (CIUS), Six-item Social Support Questionnaire (SSQ6), and The South Oaks Gambling Screen (SOGS) were used to collect data. Mediation analyses showed a significant indirect effect of compulsive Internet use and problem gambling on psychological well-being through perceived peer support. The total effects of compulsive Internet use and problem gambling on psychological well-being were negative. This study implies the significance of strengthening the knowledge about the impact of peer relationships among adolescents.