Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders

The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and “other” types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician severity ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon.     

Challenges using motivational interviewing as an adjunct to exposure therapy for obsessive-compulsive disorder

Exposure and response prevention (EX/RP) is an efficacious treatment for obsessive-compulsive disorder (OCD). However, patients often do not adhere fully to EX/RP procedures. Motivational interviewing (MI) has been shown to improve treatment adherence in other disorders. This pilot study used a randomized controlled design to examine whether MI can be successfully added to EX/RP and whether this intervention (EX/RP + MI) could improve patient adherence to between-session EX/RP procedures relative to EX/RP alone. Thirty adults with OCD were randomized to 18 sessions of EX/RP or EX/RP + MI. Therapists rated patient adherence at each exposure session. Independent evaluators assessed change in OCD and depressive symptoms, and patients completed self-report measures of readiness for change and quality of life. The two treatment conditions differed in degree of congruence with MI but not in conduct of EX/RP procedures. Both groups experienced clinically significant improvement in OCD symptoms, without significant group differences in patient adherence. There are several possible reasons why EX/RP + MI had no effect on patient adherence compared to standard EX/RP, each of which has important implications for the design of future MI studies in OCD. We recommend that MI be further evaluated in OCD by exploring alternative modes of delivery and by focusing on patients less ready for change than the current sample.     

Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression

Internet-delivered psychological treatment of major depression has been investigated in several trials, but the role of personalized treatment is less investigated. Studies suggest that guidance is important and that automated computerized programmes without therapist support are less effective. Individualized e-mail therapy for depression has not been studied in a controlled trial. Eighty-eight individuals with major depression were randomized to two different forms of Internet-delivered cognitive behaviour therapy (CBT), or to a waiting-list control group. One form of Internet treatment consisted of guided self-help, with weekly modules and homework assignments. Standard CBT components were presented and brief support was provided during the treatment. The other group received e-mail therapy, which was tailored and did not use the self-help texts i.e., all e-mails were written for the unique patient. Both treatments lasted for 8 weeks. In the guided self-help 93% completed (27/29) and in the e-mail therapy 96% (29/30) completed the posttreatment assessment. Results showed significant symptom reductions in both treatment groups with moderate to large effect sizes. At posttreatment 34.5% of the guided self-help group and 30% of the e-mail therapy group reached the criteria of high-end-state functioning (Beck Depression Inventory score below 9). At six-month follow-up the corresponding figures were 47.4% and 43.3%. Overall, the difference between guided self-help and e-mail therapy was small, but in favour of the latter. These findings indicate that both guided self-help and individualized e-mail therapy can be effective.     

Further examination of discriminated functional communication

One child with developmental disabilities was taught to mand for attention by saying "excuse me." Treatment effects were extended to multiple training contexts by teaching the participant to attend to naturally occurring discriminative stimuli through differential reinforcement of communication during periods of the experimenter's nonbusy activities (e.g., reading a magazine). Results are discussed in terms of future research on the generalization and maintenance of functional communication in the natural environment.     

EFFECTS OF TREATMENT INTEGRITY FAILURES DURING DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR: A TRANSLATIONAL MODEL

Differential reinforcement of alternative behavior (DRA) is used frequently as a treatment for problem behavior. Previous studies on treatment integrity failures during DRA suggest that the intervention is robust, but research has not yet investigated the effects of different types of integrity failures. We examined the effects of two types of integrity failures on DRA, starting with a human operant procedure and extending the results to children with disabilities in a school setting. Human operant results (Experiment 1) showed that conditions involving reinforcement for problem behavior were more detrimental than failing to reinforce appropriate behavior alone, and that condition order affected the results. Experiments 2 and 3 replicated the effects of combined errors and sequence effects during actual treatment implementation.     

A Bayesian-optimal principle for learner-friendly adaptation in learning games

Adaptive learning games should provide opportunities for the student to learn as well as motivate playing until goals have been reached. In this paper, we give a mathematically rigorous treatment of the problem in the framework of Bayesian decision theory. To quantify the opportunities for learning, we assume that the learning tasks that yield the most information about the current skills of the student, while being desirable for measurement in their own right, would also be among those that are efficient for learning. Indeed, optimization of the expected information gain appears to naturally avoid tasks that are exceedingly demanding or exceedingly easy as their results are predictable and thus uninformative. Still, tasks that are efficient for learning may be experienced as too challenging, and the resulting failures can lower motivation. Therefore, in addition to quantifying the expected informational benefit for learning of any prospective task to be presented next, we also model the expected motivational cost of its presentation, measured simply as the estimated probability of failure in our example model. We propose a “learner-friendly” adaptation algorithm that chooses the learning tasks by optimizing the expected benefit divided by the expected cost. We apply this algorithm to a Rasch-like student model implemented within a real-world application and present initial results of a pilot experiment.     

On the Speed Sensitivity Parameter in the Lognormal Model for Response Times and Implications for High-Stakes Measurement Practice

In high-stakes testing, often multiple test forms are used and a common time limit is enforced. Test fairness requires that ability estimates must not depend on the administration of a specific test form. Such a requirement may be violated if speededness differs between test forms. The impact of not taking speed sensitivity into account on the comparability of test forms regarding speededness and ability estimation was investigated. The lognormal measurement model for response times by van der Linden was compared with its extension by Klein Entink, van der Linden, and Fox, which includes a speed sensitivity parameter. An empirical data example was used to show that the extended model can fit the data better than the model without speed sensitivity parameters. A simulation was conducted, which showed that test forms with different average speed sensitivity yielded substantial different ability estimates for slow test takers, especially for test takers with high ability. Therefore, the use of the extended lognormal model for response times is recommended for the calibration of item pools in high-stakes testing situations. Limitations to the proposed approach and further research questions are discussed.     

A Signal Detection Model for Multiple-Choice Exams

A model for multiple-choice exams is developed from a signal-detection perspective. A correct alternative in a multiple-choice exam can be viewed as being a signal embedded in noise (incorrect alternatives). Examinees are assumed to have perceptions of the plausibility of each alternative, and the decision process is to choose the most plausible alternative. It is also assumed that each examinee either knows or does not know each item. These assumptions together lead to a signal detection choice model for multiple-choice exams. The model can be viewed, statistically, as a mixture extension, with random mixing, of the traditional choice model, or similarly, as a grade-of-membership extension. A version of the model with extreme value distributions is developed, in which case the model simplifies to a mixture multinomial logit model with random mixing. The approach is shown to offer measures of item discrimination and difficulty, along with information about the relative plausibility of each of the alternatives. The model, parameters, and measures derived from the parameters are compared to those obtained with several commonly used item response theory models. An application of the model to an educational data set is presented.     

Response bias,recollection, and familiarity in individuals with Highly Superior Autobiographical Memory (HSAM)

ABSTRACT

The current study focused on individuals with Highly Superior Autobiographical Memory (HSAM) and had two main objectives: 1) investigate whether HSAMs have increased recollection performance compared to controls, and 2) investigate whether HSAMs have a reliably different response bias than controls. While previous lab-based recognition tests have shown that HSAMs have normal memory performance, these tests were based on a mixture of both recollection and familiarity. Here, we employed recognition tests specifically designed to separate recollected responses from those based on familiarity. Additionally, we were interested in how HSAMs make their memory decisions. Several studies have shown a great deal of variability between individuals in their response bias. Here, individuals with HSAM and age- matched controls completed a remember/know and a source memory test. HSAMs behaved like controls in both overall and recollection-based memory discrimination. However, HSAMs showed a significantly more liberal response bias, endorsing more items as “old” than controls. These findings contribute to our understanding of how memory processes – especially those related to decision-making – function in those with superior memory abilities and may help elucidate how other (non-HSAM) memory experts make decisions.     

Retrieval of names in face and object naming in an interference study

Two experiments using the interference paradigm are reported. In the first experiment, the participants spoke aloud the names of celebrities and the names of objects when presented with pictures while hearing distractors. In the case of proper names, we replicated the data obtained by Izaute and Bonin (2001) using the interference paradigm with a proper name written naming task. In the case of common names, the results replicated those obtained by Shriefers, Meyer, and Levelt (1990). In the second experiment, the participants produced the names of celebrities when presented with their faces while hearing distractors that were either proper names associated with the celebrities (associate condition), that belonged to a different professional category (different condition), or that corresponded to the proper names of the celebrities (identical condition). For negative SOAs, “associate” distractors were found to increase latencies compared to the “different category” condition. The implications of the findings for proper name retrieval are briefly discussed.