Another missed opportunity? Recognition of alcohol use problems by mental health providers.

Alcohol use problems (AUPs) are prevalent among people seeking psychotherapy. Despite mandates from managed care companies to routinely screen for AUPs, little is known about the screening practices of providers or their ability to identify AUPs based on presenting symptoms. Participants (N = 117) read two case vignettes and suggested initial diagnoses and questions they would ask in order to clarify a diagnosis. Participants were more likely to ask about substance use and diagnose an AUP when the vignette contained explicit reference to the client's substance use as compared to a vignette where the signs of an AUP were more subtle. In both vignettes, a mental health problem was a more likely diagnosis than an AUP. Neither participant attributes nor personal or professional experiences with AUPs reliably shaped responses to the vignettes. The findings are discussed in light of their implications for future research and improved training in addictions for mental health providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Watching and drinking: Expectancies, prototypes, and friends’ alcohol use mediate the effect of exposure to alcohol use in movies on adolescent drinking.

Objective: To investigate the psychological processes that underlie the relation between exposure to alcohol use in media and adolescent alcohol use. Design: The design consisted of a structural equation modeling analysis of data from four waves of a longitudinal, nationally representative, random-digit dial telephone survey of adolescents in the United States. Main Outcome Measures: The main outcome measures were adolescent alcohol consumption and willingness to use alcohol. Tested mediators were alcohol-related norms, prototypes, expectancies, and friends’ use. Results: Alcohol prototypes, expectancies, willingness, and friends’ use of alcohol (but not perceived prevalence of alcohol use among peers) were significant mediators of the relation between movie alcohol exposure and alcohol consumption, even after controlling for demographic, child, and family factors associated with both movie exposure and alcohol consumption. Conclusion: Established psychological and interpersonal predictors of alcohol use mediate the effects of exposure to alcohol use in movies on adolescent alcohol consumption. The findings suggest that exposure to movie portrayals may operate through similar processes as other social influences, highlighting the importance of considering these exposures in research on adolescent risk behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exaggerated anxiety is not unique to CO? in panic disorder: A comparison of hypercapnic and hypoxic challenges.

Current biological models of panic disorder (PD) assert that this disorder is maintained by hypersensitivity to carbon dioxide (CO?) and related asphyxia cues, which is manifested as an exaggerated suffocation alarm (D. F. Klein, see record 1993-37796-001). Because suffocation can result from both increased CO? (hypercapnia) and decreased oxygen (O?; hypoxia), this study examined respiratory responding and anxiety during 5% CO? (a hypercapnic challenge) and 12% O? (a hypoxic challenge) in 14 PD patients and 14 matched controls (MC). Results demonstrate that irrespective of the source of suffocation, PD patients respond with increased anxiety relative to MC participants. Significant group differences were observed in respiratory functioning, with the PD patients showing higher respiratory rates in response to both challenges. The MC sample demonstrated the expected respiratory responses to both hypercapnia and hypoxia. The findings indicate that PD patients are hypersensitive to alterations in breathing and that this reactivity is not specific to CO?. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does distraction reduce the alcohol–aggression relation? A cognitive and behavioral test of the attention-allocation model.

Objective: This study provided the first direct test of the cognitive underpinnings of the attention-allocation model and attempted to replicate and extend past behavioral findings for this model as an explanation for alcohol-related aggression. Method: A diverse community sample (55% African American) of men (N = 159) between 21 and 35 years of age (M = 25.80) were randomly assigned to 1 of 2 beverage conditions (i.e., alcohol, no-alcohol control) and 1 of 2 distraction conditions (i.e., distraction, no-distraction). Following beverage consumption, participants were provoked via reception of electric shocks and a verbal insult from a fictitious male opponent. Participants' attention allocation to aggression words (i.e., aggression bias) and physical aggression were measured using a dot probe task and a shock-based aggression task, respectively. Results: Intoxicated men whose attention was distracted displayed significantly lower levels of aggression bias and enacted significantly less physical aggression than intoxicated men whose attention was not distracted. However, aggression bias did not account for the lower levels of alcohol-related aggression in the distraction, relative to the no-distraction, condition. Conclusions: These results replicated and extended past evidence that cognitive distraction is associated with lower levels of alcohol-related aggression in highly provoked males and provide the first known cognitive data to support the attentional processes posited by the attention-allocation model. Discussion focused on how these data inform intervention programming for alcohol-related aggression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Was Lars sexually assaulted? A study in the reliability of witnesses and of experts.

A 5-year-old boy reported that he had been sexually assaulted by a neighborhood window cleaner. 2 court-appointed "experts" using divergent methods of approach came up with divergent findings. Detailed interviews and the case history are presented in this article and lead to a resolution of the disagreement and a reconstruction of the incident with the conclusion that Lars was not sexually assaulted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What makes group MET work? A randomized controlled trial of college student drinkers in mandated alcohol diversion.

Nationally, college drinkers exhibit the highest rates of alcohol consumption and represent the largest percentage of problem drinkers. Group motivational enhancement therapy (GMET) has been found to catalyze problem drinking reductions among college student samples. Although research supporting the use of single-session GMET in college samples (general and mandated) is emergent, no studies have evaluated a comprehensive model of the potential active ingredients of this group intervention. College students (N = 206; 88% White; 63% men; M age = 18.6) mandated to a university alcohol diversion program were randomly assigned to 1 of 3 conditions: the standard-of-care 2-session “Focus on Alcohol Concerns” education group (FAC), a single GMET, or a single alcohol information-only control group (AI) to evaluate the role of 5 putative mediators: readiness to change, self-efficacy, perceived risk, norm estimates, and positive drinking expectancies. At 3- and 6-month follow-ups, GMET students demonstrated greater reductions in problem drinking outcomes (drinks per drinking day, hazardous drinking symptoms, and alcohol-related problems). Of the 5 mediators proposed, only self-efficacy emerged as a significant mediator. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of correlation, calibration, and diagnosticity as measures of the confidence–accuracy relationship in witness identification.

The relationship between witness confidence and accuracy (CA) has traditionally been measured by the point-biserial correlation (rpb). Recently, 2 alternative indices for measuring the CA relation have been proposed, namely calibration and diagnosticity analyses (e.g., P. Juslin, N. Olsson, & A. Winman, 1996). In this study, the 3 measures were compared quantitatively using 52 independent data sets. The measures rpb and calibration were weakly correlated, whether computed across earwitness data sets, eyewitness data sets, or all data. Thus, when applied to the same data, these 2 measures sometimes yield different conclusions. A modest relation was observed between the rpb and the diagnosticity of confidence. Finally, calibration and degree of over- and underconfidence covaried with task difficulty, consistent with K. A. Deffenbachers' (1980) optimality hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Different inhibition of conditioned avoidance response by clozapine and DA D? and D? antagonists in male mice.

The effects of clozapine (2.5 and 5 mg/kg), SCH 23390 (0.05 and 0.1 mg/kg), and raclopride (0.1 and 0.5 mg/kg) on the acquisition and performance of a conditioned avoidance response (CAR) were studied in BALB/C mice. The high dose of clozapine decreased avoidances and crossings in acquisition and performance. SCH 23390 had no effect on acquisition, whereas a decrease of avoidances and crossings was produced by the high dose in performance. The high dose of raclopride decreased avoidances and crossings in acquisition but had no effects on performance. The results suggest that the mechanisms by which these drugs affect avoidance are not the same. This difference may reflect an action on different subtypes of DA receptors that produces different effects on motor behavior. It seems that in all cases where CAR is impaired, locomotor activity is also suppressed; therefore, a parsimonious interpretation is that the CAR procedure is sensitive to motor effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does comorbid substance use disorder exacerbate borderline personality features? A comparison of borderline personality disorder individuals with vs. without current substance dependence.

There is compelling evidence that comorbid borderline personality disorder (BPD) negatively impact the clinical courses and outcomes of substance use disorders (SUD). Conversely, there is little evidence that concurrent SUD exacerbates the clinical characteristics of BPD. Thus, this study sought to examine whether the presence of current substance dependence among BPD patients would be associated with stronger BPD-relevant personality traits and behavioral characteristics. Female BPD patients without (BOR; n = 37) or with current substance dependence (BSUD; n = 19), and female non-BPD/SUD controls (CON; n = 48) were compared with respect to impulsivity, affective lability, affective intensity, externalizing behaviors, and self-harming/suicidal tendencies, taking into consideration their comorbid mood disorders, anxiety disorders, and antisocial personality disorder. Results indicated that both BOR and BSUD groups scored higher than CON in most of the measures, but BOR and BSUD failed to reveal significant group differences especially when the influence of comorbid psychopathology was removed. The overall pattern of findings remained identical even when comparing BPD patients with versus without the diagnosis of lifetime substance dependence. Our results do not support the notion that BPD individuals with SUD display more severe BPD features than individuals with BPD alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body image disturbance in body dysmorphic disorder and eating disorders. Obsessions or delusions?

At this time, the question posed by this article's title--body image disturbance in body dysmorphic disorder and eating disorders: obsessions or delusions?--is probably best answered "both." Both disorders appear to be characterized by obsessional and delusional thinking. In addition, it is likely that their nondelusional and delusional variants constitute a single disorder encompassing a spectrum of insight, with the entire spectrum characterized by obsessional thinking. This view represents a considerable departure from DSM-III-R, in which the psychotic disorders were encapsulated in a separate section of the manual and considered different disorders from their nonpsychotic variants. The one exception was the mood disorders, which were acknowledged to have psychotic variants that were classified in the manual's "nonpsychotic" section. In DSM-IV, on the basis of emerging empirical evidence about the dimensional nature of the psychotic/nonpsychotic boundary, the dichotomy between delusional and nondelusional disorders is less clear. The double coding allowed for BDD acknowledges that BDD and its delusional disorder variant may constitute a single disorder; that allowed for OCD acknowledges that OCD may be delusional. With regard to eating disorders, however, DSM-IV is surprisingly silent, perhaps because delusional preoccupations are less common than in BDD. These issues also may apply to other disorders. Like BDD, hypochondriasis is classified as a somatoform disorder, with its delusional variant a type of delusional disorder, somatic type. Do the delusional and nondelusional variants of hypochondriasis constitute the same disorder? Do other types of somatic delusional disorder, such as parasitosis and olfactory reference syndrome (the belief that one emits a foul body odor) have nondelusional variants? It is likely that a number of disorders span a spectrum from delusional to nondelusional thinking, with unlimited shades of gray in between. Future research may indicate that obsessional disorders such as BDD, anorexia, OCD, and hypochondriasis, as well as other disorders such as major depression, should have qualifiers or subtypes--for example, "with good insight," "with poor insight," and "with delusional (or psychotic) thinking"--with an implied continuum of insight embraced by a single disorder. Such an approach, which scatters psychosis throughout the nomenclature, ultimately may be shown to be a more valid and clinically useful classification approach. Answers to these questions will not only improve our classification system but also may have important treatment implications. For example, the preliminary finding that delusional BDD responds preferentially to SRIs but not to neuroleptic agents contradicts conventional wisdom about the treatment of psychosis.(ABSTRACT TRUNCATED AT 400 WORDS)     

Same wording, distinct concepts? Testing differences between expectancies and motives in a mediation model of alcohol outcomes.

Per definition, alcohol expectancies (after alcohol I expect X), and drinking motives (I drink to achieve X) are conceptually distinct constructs. Theorists have argued that motives mediate the association between expectancies and drinking outcomes. Yet, given the use of different instruments, do these constructs remain distinct when assessment items are matched? The present study tested to what extent motives mediated the link between expectancies and alcohol outcomes when identical items were used, first as expectancies and then as motives. A linear structural equation model was estimated based on a national representative sample of 5,779 alcohol-using students in Switzerland (mean age = 15.2 years). The results showed that expectancies explained up to 38% of the variance in motives. Together with motives, they explained up to 48% of the variance in alcohol outcomes (volume, 5+ drinking, and problems). In 10 of 12 outcomes, there was a significant mediated effect that was often higher than the direct expectancy effect. For coping, the expectancy effect was close to zero, indicating the strongest form of mediation. In only one case (conformity and 5+ drinking), there was a direct expectancy effect but no mediation. To conclude, the study demonstrates that motives are distinct from expectancies even when identical items are used. Motives are more proximally related to different alcohol outcomes, often mediating the effects of expectancies. Consequently, the effectiveness of interventions, particularly those aimed at coping drinkers, should be improved through a shift in focus from expectancies to drinking motives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do executive and reactive disinhibition mediate the effects of familial substance use disorders on adolescent externalizing outcomes?

The present study examined the potential mediating roles of executive and reactive disinhibition in predicting conduct problems, attention-deficit/hyperactivity disorder (ADHD) symptoms, and substance use among adolescents with and without a family history of substance use disorders. Using data from 247 high-risk adolescents, parents, and grandparents, structural equation modeling indicated that reactive disinhibition, as measured by sensation seeking, mediated the effect of familial drug use disorders on all facets of the adolescent externalizing spectrum. Executive disinhibition, as measured by response disinhibition, spatial short term memory, and “trait” impulsivity, was associated with ADHD symptoms. Moreover, although executive functioning weakness were unrelated to familial substance use disorders, adolescents with familial alcohol use disorders were at risk for “trait” impulsivity marked by a lack of planning. These results illustrate the importance of “unpacking” the broad temperament style of disinhibition and of studying the processes that underlie the commonality among facets of the externalizing spectrum and processes that predict specific externalizing outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive–behavioral, and integrative therapists.

[Correction Notice: An erratum for this article was reported in Vol 19(3) of Journal of Psychotherapy Integration (see record 2009-16521-006). The results of the post hoc tests were printed illegibly. In order to make it possible for the reader to understand which of the effect sizes belong to which of the comparisons, the tables are clarified in this erratum.] This study focuses on similarities and differences between Swedish psychotherapists of four orientations: psychodynamic, cognitive, cognitive–behavioral, and integrative therapy. The aim is to describe similarities and differences regarding (a) background factors, (b) focus in psychotherapy, (c) attitudes toward psychotherapy as art/craftsmanship, (d) scientific outlook, (e) what characterizes a good psychotherapist, and (f) how psychotherapy ought to be pursued. The therapists had very similar attitudes about the therapeutic relationship and rather similar attitudes about which effects psychotherapy ought to obtain. The greatest differences were related to psychotherapeutic techniques and science. The results are discussed with emphasis on the distance or proximity between the orientations. The conclusion is that there are differences between psychodynamic psychotherapy compared with cognitive and cognitive–behavioral therapies, which imply difficulties in integrating these orientations. However, the differences between the cognitive and cognitive–behavioral therapists are not of such a magnitude that they necessarily present an obstacle to integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heterogeneous nucleation and growth of δ′ in Al at.% Li

The nucleation of δ′ at dislocations at small undercooling is investigated. The primary site for heterogeneous nucleation is matrix dislocations with strong edge components. The edge dislocation half-plane and the development of a δ′ anti-phase boundary is considered. The morphological development of the δ′ precipitate is that of a “kidney” shape with a consistent relationship with the edge dislocation half-plabe. A model is developed based on the energetics of loss of coherency of a spherical precipitate and is employed to predict coherency loss of the δ′ precipitate and to compare it to the experimentally determined diameter of 400 nm. The loss of coherency is shown to be assisted by the growth of the equilibrium precipitate, δ.     

Cognitive–behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies.

The efficacy of cognitive–behavioral therapy (CBT) for anxiety in adults is well established. In the present study, the authors examined whether CBT tested under well-controlled conditions generalizes to less-controlled, real-world circumstances. Fifty-six effectiveness studies of CBT for adult anxiety disorders were located and synthesized. Meta-analytic effect sizes are presented for disorder-specific symptom measures as well as symptoms of generalized anxiety and depression for each disorder, and benchmarked to results from randomized controlled trials. All pretest–posttest effect sizes for disorder-specific symptom measures were large, suggesting that CBT for adult anxiety disorders is effective in clinically representative conditions. Six studies included a control group, and between-groups comparisons yielded large effect sizes for disorder-specific symptoms in favor of CBT. Benchmarking indicated that results from effectiveness studies were in the range of those obtained in selected efficacy trials. To test whether studies that are more representative of clinical settings have smaller effect sizes, the authors coded studies for 9 criteria for clinical representativeness. Results indicate an inverse relationship between clinical representativeness and outcome, but the magnitude of the relationship is quite small. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Getting in and getting money: A comparative analysis of admission standards, acceptance rates, and financial assistance across the research–practice continuum in clinical psychology programs.

The diversification and proliferation of doctoral programs in clinical psychology call for their periodic comparative analysis to inform prospective applicants, their advisors, and the entire field. The authors surveyed directors of the 232 American Psychological Association (APA)–accredited doctoral programs in clinical psychology (98% response) regarding application numbers, acceptance rates, financial assistance, and credentials of incoming students. Results are summarized for all clinical programs and then separately for 6 types of programs along the practice–research continuum: freestanding PsyD, university professional school PsyD, university department PsyD, practice-oriented PhD, equal-emphasis PhD, and research-oriented PhD. Lower acceptance rates and higher Graduate Record Examination scores were strongly associated with programs oriented toward more research training; for example, research-oriented PhD programs admitted far fewer applicants (7% vs. 50%) than did freestanding PsyD programs. Freestanding PsyD programs awarded significantly less full financial assistance to incoming students (1% vs. 89%) and required 1 less year to complete than did PhD programs. Overall, PhD-level students were more likely to secure an APA or Association of Psychology Postdoctoral and Internship Centers internship than were PsyD students. The authors conclude with observations about the historical changes and heightened differentiation of doctoral training in clinical psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of different atomic volumes in the three phases during lamellar eutectic growth. A comparison of experiment and theory in the AlAl2Cu system

The effect of different atomic volume in the three phases during lamellar eutectic growth is discussed and treated. Recent surface energy measurements have allowed a comparison to be made between experiment and theory and it is found that the spacing and undercoolings in the AlAl₂Cu system agree well with theory.     

Life stress, physiological and subjective indexes of negative emotionality, and coping reasons for drinking: Is there evidence for a self-medication model of alcohol use?

Alcohol use is often viewed as means of coping with distress, but support for this model has been inconsistent. The author examined stress and negative emotionality and their interaction as predictors of drinking motives in a sample of college drinkers. Both physiological and self-reported reactivity to a mood induction, and self-reported trait negative affect, were assessed. High stress was associated with coping motives, particularly among individuals who exhibited electrodermal reactivity to the mood induction. Respiratory sinus arrhythmia (RSA) reactivity was associated with coping motives. Electrodermal and RSA reactivity and stress were unrelated to enhancement and social motives. Self-reported mood reactivity and trait negative affect were not associated with any of the drinking motives. These findings offer some support for the self-medication model of alcohol use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural Features and Properties of Alloy 84% WC ― 16% Co,Obtained by Hot Pressing in the Solid and Liquid Phases. Part 1. Effect of the Temperature at which the Specimens are Prepared on Their Density and Structure

Studies are made of changes in the porosity and structure of a hard alloy obtained by hot pressing and sintering within a broad range of temperatures (950-1450°C). The effect of solid- and liquid-phase annealing on their porosity and structure is also examined. It is shown that the hot-pressed specimens are denser than the sintered specimens within the solid-phase region, other conditions being equal. Solid-phase annealing of hot-pressed and sintered specimens increases the density of both types of specimens, but the annealing operation is more effective in the former case. It is established that the open pore channels are 2-3 times smaller in the hot-pressed specimens than in the sintered specimens and are no larger than the average size of the tungsten carbide particles. Active growth of the carbide particles and redistribution of the ductile phase are observed even in the solid phase. The carbide particles grow considerably faster (by a factor of four) at sintering temperatures above 1200°C.