Does coping predict CO2-induced panic in patients with panic disorder?

Patients with panic disorder (PD) show maladaptive coping but the role of coping in the pathogenesis of panic is unclear. This study examined general coping and panic-specific coping as predictors of fear responding to CO2 inhalation. Subjective and physiological responses including panic attacks were assessed in 45 patients with PD and 45 matched nonclinical controls. Measures of coping were the primary predictors used in the analyses. Consistent with other reports, patients with PD reported increased emotion-focused coping and there was an association between emotion-focused coping and subjective reactivity. However, only panic-specific coping predicted panic attacks in response to the CO2 challenge.     

Cognitive therapy for post-traumatic stress disorder: development and evaluation

The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.     

Not just right experiences and obsessive-compulsive features: experimental and self-monitoring perspectives

Individuals with obsessive-compulsive disorder (OCD) often report compulsions aimed at reducing feelings of something not being just right or sensations of incompleteness. Research using self-report questionnaires has demonstrated a link between not just right experiences (NJREs) and OCD symptoms (Behav. Res. Therapy 41 (2003) 681; Anxiety, 1 (1995) 208). Extending previous work, this paper presents experimental and self-monitoring data on NJREs in an undergraduate sample. NJREs produced distress and urges to change something, but feared consequences were rare. Stronger responses were found for naturally occurring self-monitored NJREs compared to NJREs elicited in the laboratory. Several significant relationships were found between features of NJREs and OC symptoms and constructs theoretically related to OCD (e.g., responsibility, incompleteness), but no significant relationships were found between features of NJREs and non-OCD-related constructs (worry, depressive symptoms, social anxiety). Further consideration of NJREs will be useful in improving our understanding of the phenomenology, neurobiological substrates, and treatment, of OCD.     

Perception of control over anxiety mediates the relation between catastrophic thinking and social anxiety in social phobia

Cognitive models of social phobia (social anxiety disorder) assume that individuals with social phobia experience anxiety in social situations in part because they overestimate the social cost associated with a potentially negative outcome of a social interaction. Some emotion theorists, on the other hand, point to the perception of control over anxiety-related symptoms as a determinant of social anxiety. In order to examine the relationship between perceived emotional control (PEC), estimated social cost (ESC), and subjective anxiety, we compared three alternative structural equation models: Model 1 assumes that PEC and ESC independently predict social anxiety; Model 2 assumes that ESC partially mediates the relationship between PEC and anxiety, and Model 3 assumes that PEC partially mediates the relationship between ESC and anxiety. We recruited 144 participants with social phobia and administered self-report measures of estimated social cost, perceived anxiety control, and social anxiety. The results support Model 3 and suggest that "costly" social situations are anxiety provoking in part because social phobic individuals perceive their anxiety symptoms as being out of control.     

The effects of sleep disruption on the treatment of a feeding disorder

We evaluated the effects of sleep disruption on the mealtime behavior of a young boy with developmental disabilities. Results showed that bite acceptance was less likely to persist during meals following disrupted sleep, but only when escape extinction was not implemented. Findings are discussed in terms of establishing operations and the effects of sleep disruption on the assessment and treatment of feeding problems.     

Derived manding in children with autism: synthesizing Skinner's verbal behavior with relational frame theory

Mand functions for two stimuli (A1 and A2) were trained for 3 children with autism and were then incorporated into two related conditional discriminations (A1-B1/A2 -B2 and B1-C1/B2-C2). Tests were conducted to probe for a derived transfer of mand response functions from A1 and A2 to C1 and C2, respectively. When 1 participant failed to demonstrate derived transfer of mand response functions, transfer training using exemplars was conducted. When participants had demonstrated derived transfer of mand functions, the X1 and X2 tokens that were employed as reinforcers for mand responses were incorporated into two conditional discriminations (X1-Y1/X2-Y2 and Y1-Z1/Y2-Z2). Tests were conducted for derived transfer of reinforcing functions. Finally, tests were conducted to determine if the participants would demonstrate derived manding for the derived reinforcers (present C1 and C2 to mand for Z1 and Z2, respectively). Derived transfer of functions was observed when the sequence of training and testing was reversed (i.e., training and testing reinforcing functions before mand response functions) and when only minimal instructions were provided.     

Evaluation of pharmacological treatment of impulsivity in children with attention deficit hyperactivity disorder

We used an assessment that involved competing reinforcer dimensions in a concurrent-schedules arrangement to examine the effects of stimulant medication on impulsivity (i.e., sensitivity of choices to reinforcer immediacy relative to rate, quality, and effort) with 4 students with attention deficit hyperactivity disorder. The assessments were administered in the context of a double-blind, placebo-controlled, counterbalanced reversal design. Reinforcer immediacy was the most influential dimension for 3 of the students and the second most influential dimension for 1 of the students across placebo and medication conditions; medication did not affect these sensitivities.     

Behavioral assessment of impulsivity: a comparison of children with and without attention deficit hyperactivity disorder

We conducted a brief computer-based assessment involving choices of concurrently presented arithmetic problems associated with competing reinforcer dimensions to assess impulsivity (choices controlled primarily by reinforcer immediacy) as well as the relative influence of other dimensions (reinforcer rate, quality, and response effort), with 58 children. Results were compared for children with attention deficit hyperactivity disorder (ADHD) who were and were not receiving medication, and with typically developing children without ADHD. Within-subject and between-groups analyses of the ordinal influence of each of the reinforcer dimensions were conducted using both time- and response-allocation measures. In general, the choices of children with ADHD were most influenced by reinforcer immediacy and quality and least by rate and effort, suggesting impulsivity. The choices of children in the non-ADHD group were most influenced by reinforcer quality, and the influence of immediacy relative to the other dimensions was not statistically significant. Results are discussed with respect to the implications for assessment and treatment of ADHD.     

Marital Conflict Among Parents: Implications for Family Therapy with Adolescent Conduct Disorder

Conduct disorder is associated with several causative and maintaining factors, with family functioning being an important one. This is especially true in the Indian context, where a lot of the problem behaviors manifested by adolescents with conduct disorders are in the family context. Marital relationship of the parents is a key aspect of family functioning, affecting a number of other dimensions of family functioning, including adolescent adjustment. The paper highlights the role of parents’ marital conflict in the emergence and maintenance of adolescent conduct problems. The importance of family therapy in managing adolescent conduct disorder is discussed through case examples from India. Shalini Anant, MPhil, PhD Scholar, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India. Ahalya Raguram, PhD, Additional Professor, Department of Clinical Psychology, NIMHANS, Bangalore 560029, India. Address correspondence to Shalini Anant (shalinianant@gmail.com).     

Understanding the Covariation Among Childhood Externalizing Symptoms: Genetic and Environmental Influences on Conduct Disorder,Attention Deficit Hyperactivity Disorder,and Oppositional Defiant Disorder Symptoms

Conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) are common childhood externalizing disorders that frequently co-occur. However, the causes of their comorbidity are not well understood. To address that question, we analyzed data from > 600 Finnish twin pairs, who completed standardized interviews at age 14. Behavior genetic methods were used to examine how genetic/environmental factors contribute to each disorders symptoms and to their covariation. We found significant genetic effects on each disorder with only modest evidence of shared environmental influences. Our data suggest the comorbidity among CD, ADHD, and ODD is primarily explained by shared genetic influences; however, each disorder was also under unique genetic influence, supporting the distinction of each disorder.