BRAIN, SYMBOL, & EXPERIENCE: A PSYCHIATRIC AND THEOLOGICAL DIALOGUE

Abstract. Brain, Symbol & Experience attempts to solidify the authors' work in the fields of neurophenomenology and consciousness. The interdisciplinary nature of the work dictates less than extensive discussions of individual academic topics, but it does facilitate the identification of mutual points of interest for future pluralistic dialogues. This paper explores the implications of Laughlin, McManus, and d'Aquili for the neurosciences, psycho-pathology, psychotherapy, contemporary literature, theology, and faith development theory. Suggestions for specific interdisciplinary conversations are offered.     

Discomfort with space and motion: A possible marker of vestibular dysfunction assessed by the situational characteristics questionnaire

Space and motion discomfort (SMD) refers to the situational specificity of symptoms occurring in some patients with vestibular dysfunction, such as those with balance disorders and some with panic disorder. SMD occurs in situations characterized by inadequate visual or kinesthetic information for normal spatial orientation. We report the results of two studies of the construct validity of the Situational Characteristics Questionnaire (SitQ), which has two subscales, both of which measure SMD: the SMD-I and SMD-II. In Study 1, the SitQ was administered to members of a self-help group for balance disorders, a psychiatric sample consisting of patients with panic disorder, nonpanic anxiety disorders, depression, and a sample of normals. SMD levels were the highest in the self-help balance group, next to the highest in the panic groups, and lowest in the remaining groups. In Study 2, the SitQ was administered to otolaryngological patients with vestibular dysfunction and to patients with hearing loss. SMD levels were higher in the vestibular patients. Data on internal consistency, test-retest reliability, and convergent and discriminant validity are presented. The SitQ, particularly the SMD-II, is recommended for quantifying space and motion discomfort in patients with anxiety and/or balance disorders.Study 1 was funded by MH 40757. Study 2 was funded by a grant from the Upjohn Company and MH 19816.     

Binge Eating,Purging, and Restriction Symptoms: Increasing Accuracy of Prediction Using Machine Learning

Eating disorders are severe mental illnesses characterized by the hallmark behaviors of binge eating, restriction, and purging. These disordered eating behaviors carry extreme impairment and medical complications, regardless of eating disorder diagnosis. Despite the importance of these disordered behaviors to every eating disorder diagnosis, our current models are not able to accurately predict behavior occurrence. The current study utilized machine learning to develop longitudinal predictive models of binge eating, purging, and restriction in an eating disorder sample (N = 60) using real-time intensive longitudinal data. Participants completed four daily assessments of eating disorder symptoms and emotions for 25 days on a smartphone (total data points per participant = 100). Using data, we were able to compute highly accurate prediction models for binge eating, restriction, and purging (.76–.96 accuracy). The ability to accurately predict the occurrence of binge eating, restriction, and purging has crucial implications for the development of preventative interventions for the eating disorders. Machine learning models may be able to accurately predict onset of problematic psychiatric behaviors leading to preventative interventions designed to disrupt engagement in such behaviors.     

Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders

Despite striking empirical support, exposure-based treatments for anxiety disorders are underutilized. This is partially due to clinicians’ concerns that patients may reject exposure or experience severe side effects, particularly in intensive forms of exposure. We examined acceptance and side effects of two randomly assigned variants of prediction error-based exposure treatment differing in temporal density (1 vs. 3 sessions/week) in 681 patients with panic disorder, agoraphobia, social anxiety disorder, and multiple specific phobias. Treatment acceptance included treatment satisfaction and credibility, engagement (i.e., homework completion), and tolerability (i.e., side effects, dropout, and perceived treatment burden). Side effects were measured with the Inventory for the Balanced Assessment of Negative Effects of Psychotherapy (INEP). We found treatment satisfaction, credibility, and engagement to be equally high in both variants of exposure-based treatment, despite higher treatment burden (β = 0.25) and stronger side effects (β = 0.15) in intensified treatment. 94.1% of patients reported positive effects in the INEP. 42.2% reported side effects, with treatment stigma (16.6%), low mood (14.8%) and the experience to depend on the therapist (10.9%) being the most frequently reported. The mean intensity of side effects was low. We conclude that prediction error-based exposure treatment is well accepted by patients with different anxiety disorders and that patients also tolerate temporally intensified treatment, despite higher perceived treatment burden and stronger side effects. Clinicians should be aware of the most frequent side effects to take appropriate countermeasures. In sum, temporal intensification appears to be an acceptable strategy to achieve faster symptom reduction, given patients’ well-informed consent.     

Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders

Comorbid substance use disorders (SUDs) and mental health disorders are a pervasive problem among post-9/11 veterans and service members. Treatment of SUD and comorbid disorders has historically occurred separately and sequentially, and when treated concurrently has been primarily done in a weekly outpatient setting, which has high rates of dropout. The current study describes an integrated 2-week intensive outpatient treatment (IOP) using cognitive-behavioral therapy, including prolonged exposure for posttraumatic stress disorder (PTSD), unified protocol for anxiety and mood disorders, and relapse prevention for SUD. Forty-two patients completed the comorbid treatment program. Results indicated that self-reported substance use, PTSD, and depression symptoms significantly decreased following treatment, while satisfaction with participation in social roles increased. These preliminary effectiveness data indicate that comorbid SUD and mental health disorders can be effectively treated in a 2-week intensive outpatient program.     

执行控制资源损耗对自传体记忆生动性和情绪的影响

旨在探究健康个体执行控制资源损耗对自传体记忆生动性及情绪的影响。实验一采用Stroop任务探讨了一般执行控制资源损耗的影响,结果发现损耗组自传体记忆生动性和情绪强度显著低于控制组。实验二进一步探讨不同的执行控制资源损耗的影响,结果显示中央执行的资源损耗对生动性和情绪强度影响最大,而视空间模板与语音环之间没有显著差异。实验结果支持了自传体记忆的执行控制资源受损理论和资源有限理论,并对临床治疗具有实际应用价值。     

The role of the school psychologist in the inclusive education of school-age children with autism spectrum disorders

Two independent trends are impacting school psychologists with regard to their involvement in the education of students with autism spectrum disorders (ASDs): increasing prevalence estimates of ASDs and an emphasis on the inclusion of students with special needs in regular education classrooms. In light of these trends and growing awareness of the need for evidence-based practices in the field, school psychologists can expect to be involved in the educational programming of students with ASDs and should be knowledgeable about empirically supported strategies relevant to inclusive education of these children. The purpose of this review is to familiarize school psychologists with currently available intervention techniques by describing each strategy and outlining the degree of empirical support for each. Strategies for managing disruptive behaviors, promoting learning, and facilitating social integration are reviewed.     

Total number of MMPI-2 clinical scale elevations predicts premature termination after controlling for intake symptom severity and personality disorder diagnosis

Premature termination of therapy by patients is a common phenomenon that can be deleterious to treatment outcome for patients and also negatively affect therapists, treatment centers, and research programs. Therefore, a method of identifying patients at risk for premature termination could have widespread benefits. This study investigated whether patients’ MMPI-2 profiles, including clinical scale elevations and Negative Treatment Indicator (TRT) scores, could predict premature termination in an outpatient sample, controlling for personality disorder diagnosis and symptom severity at intake. Results indicated that while TRT scores were not incrementally predictive of premature termination, the total number of clinical scale elevations was significantly incrementally predictive of dropout. Clinical implications are discussed.     

The Role of Self-Objectification in the Experience of Women with Eating Disorders

Objectification theory has linked self-objectification to negative emotional experiences and disordered eating behavior in cultures that sexually objectify the female body. This link has not been empirically tested in a clinical sample of women with eating disorders. In the present effort, 209 women in residential treatment for eating disorders completed self-report measures of self-objectification, body shame, media influence, and drive for thinness on admission to treatment. Results demonstrated that the internalization of appearance ideals from the media predicted self-objectification, whereas using the media as an informational source about appearance and feeling pressured to conform to media ideals did not. Self-objectification partially mediated the relationship between internalized appearance ideals and drive for thinness; internalized appearance ideals continued to be an independent predictor of variance. In accordance with objectification theory, body shame partially mediated the relationship between self-objectification and drive for thinness in women with eating disorders; self-objectification continued to be an independent predictor of variance. These results illustrate the importance of understanding and targeting the experience of self-objectification in women with eating disorders or women at risk for eating disorders.