Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial

This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up period. Patients were randomly assigned to receive either immediate treatment with the UP (n=26) or delayed treatment, following a 16-week wait-list control period (WLC; n=11). The UP resulted in significant improvement on measures of clinical severity, general symptoms of depression and anxiety, levels of negative and positive affect, and a measure of symptom interference in daily functioning across diagnoses. In comparison, participants in the WLC condition exhibited little to no change following the 16-week wait-list period. The effects of UP treatment were maintained over the 6-month follow-up period. Results from this RCT provide additional evidence for the efficacy of the UP in the treatment of anxiety and comorbid depressive disorders, and provide additional support for a transdiagnostic approach to the treatment of emotional disorders.     

Bridging the HIV Divide: Stigma,Stories and Serodiscordant Sexuality in the Biomedical Age

At a time when advances in biomedicine have rendered people with HIV non-infectious under certain conditions, much public discourse on HIV remains stuck in a paradigm of ‘risk’, which does little to lessen the divide between people with and without HIV in society or challenge the way intimate relationships across this divide are typically stigmatised as undesirable and problematic. We rarely hear the stories of couples who live with mixed HIV statuses and how they themselves perceive and manage their so called ‘serodiscordance’. In this article, we examine such stories by mixed-status couples in Australia. In stark contrast to the dominant discourse, these couples invoked narratives of love, the everyday unimportance and manageability of HIV, and recent developments in HIV medicine, thereby challenging the way serodiscordant sexuality has been cast in public health research. Drawing on Ken Plummer’s work on hidden sexual stories, we consider not only the content of their stories, but the broader significance of stories to the world in which they are enacted, of storytelling as a rally for social and political recognition and legitimacy. Reflecting on our own role in the co-production of research stories, we argue that by moving marginalised sexual stories out of silence, stigmatised communities and researchers can conjointly and incrementally shape a new public discourse and new forms of ‘intimate citizenship’.     

Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data

The Unified Protocol (UP) is a transdiagnostic, emotion-focused cognitive-behavioral treatment developed to be applicable across the emotional disorders. The UP consists of 4 core modules: increasing emotional awareness, facilitating flexibility in appraisals, identifying and preventing behavioral and emotional avoidance, and situational and interoceptive exposure to emotion cues. Here we present data from 2 open clinical trials. In the first trial, an initial version of the UP was administered to a heterogeneous clinical sample, yielding significant pre- to posttreatment effects across disorders on a variety of measures. Analyses of clinical significance demonstrated modest results, with 56% of participants achieving responder status and 33% achieving high end-state functioning. Further manual development ensued, resulting in specific modifications and enhancements to core treatment components, and a second trial presents data from an additional pilot study of this revised version of the UP. Results from this trial demonstrated more robust treatment effects, with 73% achieving responder status and 60% achieving high end-state functioning. Results improved further at 6-month follow-up, with 85% classified as treatment responders and 69% achieving high end-state functioning. Implications for the treatment of emotional disorders as well as dimensional conceptualizations of psychopathology are discussed.     

Spatial cognition in the gerbil: computing optimal escape routes from visual threats

Previous studies in our laboratory have shown that when presented with a sudden stimulus simulating an oncoming predator, Mongolian gerbils can compute the optimal trajectory to a safe refuge, taking into account the position of the threat, the location of a clearly visible refuge, and several other contextual variables as well. In the present studies, the main goal was to explore the abilities of gerbils to use mental representations of spaces that were visually occluded by opaque barriers to compute efficient escape trajectories. In all studies, gerbils were placed into a round open field containing a single refuge. On each trial, an overhead visual stimulus was caused to ‘fly’ overhead, eliciting robust escape movements from the gerbils. By manipulating the shape and position of a series of opaque barriers that were interposed between the gerbils and the refuge, we were able to show that gerbils can compute the shortest route to an invisible target, even when the available routes to the target are made complex by using elaborate barrier shapes. These findings suggest that gerbils can maintain representations of their locations with respect to salient environmental landmarks and refuges, even when such locations are not continuously visible.     

The belief in a just world and immanent justice reasoning in adults

Deciding that negative experiences are punishment for prior misdeeds, even when plausible causal links are missing, is immanent justice (IJ) reasoning (Piaget, 1932/1965). Three studies examined a just world theory analysis of IJ reasoning in adults (Lerner, 1980). Studies 1 and 2 varied the valence of a target person's behavior prior to them experiencing an unrelated negative (car accident, Study 1) or positive (lottery win, Study 2) outcome. Participants viewed the outcomes as the result of prior behavior most when they fit deservingness expectations (good person won the lottery, bad person injured in automobile accident), suggesting that just world concerns influenced IJ reasoning. The lottery-winning finding (Study 2) also extends IJ reasoning to positive experiences. A third study found that a manipulation of just world threat in one context (prolonged or ended suffering of an HIV victim) influenced IJ responses in a subsequent unrelated context (automobile accident scenario).     

Plasticity of the association between visual space and action space in a blind-walking task

Many experiments have shown that a brief visual preview provides sufficient information to complete certain kinds of movements (reaching, grasping, and walking) with high precision. This suggests that participants must possess a calibration between visual target location and the kinaesthetic, proprioceptive, and/or vestibular stimulation generated during movement towards the target. We investigated the properties of this calibration using a cue-conflict paradigm in which participants were trained with mismatched locomotor and visual input. After training, participants were presented with visual targets and were asked to either walk to them or locate them in a spatial updating task. Our results showed that the training was sufficient to produce significant, systematic miscalibrations of the association between visual space and action space. These findings suggest that the association between action space and visual space is modifiable by experience. This plasticity could be either due to modification of a simple, task-specific sensory motor association or it could reflect a change in the gain of a path integration signal or a reorganisation of the relationship between perceived space and action space. We suggest further experiments that might help to distinguish between these possibilities.     

The effects of justice motivation on memory for self- and other-relevant events

We examined whether people might distort and selectively remember the past in ways that enable them to sustain a belief in a just world (BJW; Lerner, M. J. (1980). The belief in a just world: A fundamental delusion. New York: Plenum Press). In Study 1, recall of a lottery prize reflected participants’ justice concerns, such that the average lottery amount recalled was lowest when a “bad” versus “good” person won. In Study 2, an unrelated experience of just world threat (versus affirmation) enhanced biased recall of the lottery prize when the winner was undeserving. In Study 3, participants who experienced a fortuitous bad break selectively remembered more bad deeds from their recent past, whereas participants who experienced a good break selectively remembered more good deeds. Study 4 demonstrates that such selective memory biases specifically serve to portray chance outcomes as more fair. Taken together, these findings offer support for the notion that reconstructing and selectively recalling the past can serve to sustain a BJW.     

Restorative effects of virtual nature settings

Previous research regarding the potential benefits of exposing individuals to surrogate nature (photographs and videos) has found that such immersion results in restorative effects such as increased positive affect, decreased negative affect, and decreased stress. In the current experiment, we examined whether immersion in a virtual computer-generated nature setting could produce restorative effects. Twenty-two participants were equally divided between two conditions, while controlling for gender. In each condition, participants performed a stress-induction task, and were then immersed in virtual reality (VR) for 10 minutes. The control condition featured a slide show in VR, and the nature experimental condition featured an active exploration of a virtual forest. Participants in the nature condition were found to exhibit increased positive affect and decreased stress after immersion in VR when compared to those in the control condition. The results suggest that immersion in virtual nature settings has similar beneficial effects as exposure to surrogate nature. These results also suggest that VR can be used as a tool to study and understand restorative effects.     

Neurobiological correlates of cognitions in fear and anxiety: A cognitive–neurobiological information-processing model

We review likely neurobiological substrates of cognitions related to fear and anxiety. Cognitive processes are linked to abnormal early activity reflecting hypervigilance in subcortical networks involving the amygdala, hippocampus, and insular cortex, and later recruitment of cortical regulatory resources, including activation of the anterior cingulate cortex and prefrontal cortex to implement avoidant response strategies. Based on this evidence, we present a cognitive–neurobiological information-processing model of fear and anxiety, linking distinct brain structures to specific stages of information processing of perceived threat.     

A comparison of visual and nonvisual sensory inputs to walked distance in a blind-walking task

Two experiments were conducted in order to assess the contribution of locomotor information to estimates of egocentric distance in a walking task. In the first experiment, participants were either shown, or led blind to, a target located at a distance ranging from 4 to 10 m and were then asked to indicate the distance to the target by walking to the location previously occupied by the target. Participants in both the visual and locomotor conditions were very accurate in this task and there was no significant difference between conditions. In the second experiment, a cue-conflict paradigm was used in which, without the knowledge of the participants, the visual and locomotor targets (the targets they were asked to walk to) were at two different distances. Most participants did not notice the conflict, but despite this their responses showed evidence that they had averaged the visual and locomotor inputs to arrive at a walked estimate of distance. Together, these experiments demonstrate that, although they showed poor awareness of their position in space without vision, in some conditions participants were able to use such nonvisual information to arrive at distance estimates as accurate as those given by vision.