Year of Zoom in a Year of Doom: Lessons Learned Delivering ERP Remotely During the COVID-19 Pandemic

In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP’s emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.     

Video playback,affective witnessing,and the mobility of trauma: Video evidence of violent crime in the criminal justice system

In today's technologically mediated society, video is increasingly relied upon as an objective and reliable source of evidence in the investigation and prosecution of violent crimes. The now pervasive presence of violent video in the criminal justice system, however, presents new challenges for understanding repeated work-related exposure to and witnessing of potentially traumatic material and its impacts. Thus, this project seeks to qualitatively examine the relational affective processes that occur among criminal justice professionals when violent crimes are captured on video. We present four key categories organized around the circumstances of exposure and its impacts: 1) playback in the investigative and pre-trial process; 2) sharing videos among colleagues; 3) playing videos for victims, witnesses, and families and; 4) transmission in the broader public. Findings suggest this work involves deeply embodied processes where video evidence of violent crime enables a virtual presence at scenes and an emotional proximity to events through new forms of witnessing. These affective experiences are one relational dynamic that keeps witnessing active, thus expanding the mobility of trauma, its reach and potential impacts.     

死亡凸显对自我姓名注意瞬脱对抗效应的影响

已有研究表明死亡凸显会抑制自我面孔和自我参照记忆加工的自我优势,可是死亡凸显对自我姓名的影响尚不明确,本研究采用事件相关电位技术,探索死亡凸显对自我姓名注意瞬脱对抗效应及其大脑神经活动的影响。58名被试在经历不同的启动任务后,完成自我姓名、朋友姓名和名人姓名的注意瞬脱任务。行为结果发现自我姓名识别正确率显著高于朋友姓名和名人姓名,表现出稳定的自我姓名加工的注意瞬脱对抗效应;电生理数据发现死亡启动后自我姓名诱发的P300波幅显著低于消极启动组和中性启动组,而朋友姓名和名人姓名并不受启动的影响。本研究结果与以往研究结果共同表明死亡想法凸显会使个体将抑制自我加工（自我姓名、自我面孔和自我参照记忆）作为应对远端死亡焦虑的一种手段。     

Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

Old Fears Die Hard: Return of Public Speaking Fear in a Virtual Reality Procedure

Exposure-based therapy is an effective treatment for social anxiety, but some patients relapse. We used a novel virtual reality procedure to examine spontaneous recovery (i.e., a return of fear over time) and fear renewal (i.e., the return of fear after a context switch) in individuals with fear of public speaking. On Day 1, 32 participants received exposure training before a virtual audience. On Day 8, participants completed a spontaneous recovery phase, followed by a fear renewal test, in which they gave a presentation in front of a new (context switch) or the same audience (no context switch). After exposure, participants exhibited a lower heart rate, subjective distress, negative valence, and arousal. One week later, participants showed spontaneous recovery of heart rate, and the context switch group showed renewal of subjective distress, negative valence, and arousal. Future studies can use this procedure to test interventions aimed at improving long-term exposure effects in individuals with public speaking fear.     

Synchrony in mother-infant vocal interactions revealed through timed event sequences

This report extends a previous cross-cultural study of synchrony in mother-infant vocal interactions (Bornstein et al., 2015) to immigrant samples. Immigrant dyads from three cultures of origin (Japan, South Korea, South America) living in the same culture of destination (the United States) were compared to nonmigrant dyads in those same cultures of origin and to nonmigrant European American dyads living in the same culture of destination (the United States). This article highlights an underutilized analysis to assess synchrony in mother-infant interaction and extends cross-cultural research on mother-infant vocal interaction. Timing of onsets and offsets of maternal speech to infants and infant nondistress vocalizations were coded separately from 50-min recorded naturalistic observations of mothers and infants. Odds ratios were computed to analyze synchrony in mother-infant vocal interactions. Synchrony was analyzed in three ways -- contingency of timed event sequences, mean differences in contingency by acculturation level and within dyads, and coordination of responsiveness within dyads. Immigrant mothers were contingently responsive to their infants’ vocalizations, but only Korean immigrant infants were contingently responsive to their mothers’ vocalizations. For the Japanese and South American comparisons, immigrant mothers were more contingently responsive than their infants (but not robustly so for South American immigrants). For the Korean comparison, mean differences in contingent responsiveness were found among acculturation groups (culture of origin, immigrant, culture of destination), but not between mothers and infants. Immigrant dyads’ mean levels of responsiveness did not differ. Immigrant mothers’ and infants’ levels of responsiveness were coordinated. Strengths and flexibility of the timed event sequential analytic approach to assessing synchrony in mother-infant interactions are discussed, particularly for culturally diverse samples.     

Conducting Prolonged Exposure for PTSD During the COVID-19 Pandemic: Considerations for Treatment

The unprecedented effects and duration of the COVID-19 crisis are likely to elevate the population’s level of anxiety due to psychological stress, economic hardship, and social isolation. This effect may be especially potent for individuals with preexisting mental health conditions, such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) therapy is a highly effective treatment for PTSD across trauma-exposed populations, and has been implemented effectively via telehealth. Nevertheless, PE implementation via telehealth may require specific adaptations during the COVID-19 crisis due to public health mandates calling for sheltering in place and physical distancing. This paper discusses strategies for implementing PE for PTSD during the COVID-19 pandemic, which may also be applied to other situations in which physical distancing must be considered.     

即刻消退缺损的原因分析及其神经生物学机制

即刻消退缺损(immediate extinction deficit, IED)是指在条件性恐惧习得后, 立即进行的消退训练不能长期抑制恐惧记忆的现象。IED可能与消退起始时的应激水平和事件分割等因素有关。在高应激水平下, 消退记忆的巩固受损导致IED; 而在中等或较低的应激水平条件下, 即刻消退有效但效果可能容易受事件分割的影响。IED的神经生物学机制涉及应激激活蓝斑去甲肾上腺素能系统, 去甲肾上腺素引起杏仁核基底外侧核(basolateral amygdala, BLA)过度兴奋, 然后BLA通过投射突触抑制在恐惧消退中起核心作用的内侧前额叶神经元的活动。未来研究应注意即刻消退缺损引起的长期后果, 并深入探讨如何优化即刻消退在临床上的应用。     

生涯适应力与择业焦虑：注意偏向和归因的认知加工作用

为了探讨生涯适应力与择业焦虑的关系及内部的认知加工过程。采用点探测范式测量注意偏向,问卷法调查大学生的生涯适应力、归因和择业焦虑。结果发现：（1）生涯适应力既能直接负向预测择业焦虑,又能通过积极事件归因方式、及注意偏向和积极事件归因方式的链式中介作用间接预测择业焦虑。（2）在生涯适应力与择业焦虑的关系中受到消极事件归因方式的调节作用：只有消极事件积极归因时,生涯适应力才会影响择业焦虑。研究结果揭示了择业焦虑的内部作用过程,丰富了生涯适应力通过注意偏向和积极事件归因方式影响择业焦虑的解释视角,为通过归因和注意偏向的调整缓解不同生涯适应力个体择业焦虑提供了重要参考。