Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder

The majority of treatment research on OCD has focused on pre/post treatment efficacy of exposure-based interventions, with less attention directed towards (a) understanding mechanisms of change, and (b) maximizing long-term effectiveness. Inhibitory learning theory (ILT) provides a novel foundation for understanding how exposure therapy reduces fear. Moreover, ILT is consistent with empirical evidence that raises questions about the more traditional (i.e., habituation) explanation for exposure therapy's efficacy. Yet ILT has yet to be applied to understanding the treatment of OCD and its heterogeneity. The current review is an examination of human experimental research on ILT that seeks to translate laboratory findings on fear extinction to exposure therapy across empirically established OCD symptom dimensions. We provide an up-to-date critical review of the existing evidence for a series of strategies derived from ILT that have been proposed for the treatment of fear, discuss the limitations of existing studies, and provide suggestions for future research within this rapidly accelerating area of study. We also offer conceptual considerations for applying these principles to the treatment of OCD symptom dimensions. A common theme is the idea of introducing "desirable difficulties" into the implementation of exposure in order to foster more durable long-term learning

The Relative Contributions of Experiential Avoidance and Distress Tolerance to OC Symptoms

Background: Obsessive beliefs account for substantial (but not all) obsessive-compulsive (OC) symptoms. Intolerance of internal experiences (IIE), which encompasses the constructs of experiential avoidance (EA) and distress tolerance (DT), refers to difficulty managing unwanted thoughts, emotions, and other internal states, and might add to current explanatory models. Although IIE appears to be conceptually relevant to obsessive-compulsive (OC) symptoms, scant research has examined this relationship empirically. Aim: The present study examined the relative contributions of EA and DT as predictors of OC symptom dimensions. Method: A nonclinical sample ( n = 496) completed self-report questionnaires measuring general distress, EA, DT and OC symptom dimensions. Results: All variables of interest were significantly (all p s ≤ .001) correlated with one another, such that higher general distress, higher EA, and lower DT were associated with greater OC symptom severity for all symptom dimensions; however, only EA independently predicted obsessional symptoms, but not other OC symptom dimensions. Conclusions: One's willingness to endure (i.e. EA), rather than their ability to tolerate (i.e. DT) unpleasant internal experiences best predicts obsessional symptoms (i.e. obsessing) above and beyond general distress. Potential implications for understanding, assessing, and treating OC symptoms are discussed

Enhancing the ecological validity of the Beads Task as a behavioral measure of intolerance of uncertainty

To broaden the measurement of intolerance of uncertainty (IU) beyond self-report methods, recent research has examined the Beads Task as a behavioral measure of IU. In the present study, we enhanced this task to increase its ecological validity by maximizing decisional uncertainty and the importance of a correct response. Undergraduate participants (n=102) completed the Beads Task with instructions that they would complete the Cold Pressor Task (CPT) if they answered incorrectly. As hypothesized, baseline CPT endurance time and self-reported pain level were weakly associated with later Beads Task distress during the decision-making process. Furthermore, in vivo Beads Task distress was associated with self-report inhibitory IU, which measures avoidance and paralysis in the face of uncertainty, but not with prospective IU, perfectionism, or general psychological distress after making statistical adjustments for multiple comparisons. Comparisons to previous work using the Beads Task, clinical implications, and avenues for future research are discussed

Fluoroquinolone resistance during 2000–2005 : An observational study

<p>Abstract</p> <p>Background</p> <p>Moxifloxacin is a respiratory fluoroquinolone with a community acquired pneumonia indication. Unlike other fluoroquinolones used in our healthcare system, moxifloxacin's urinary excretion is low and thus we hypothesized that increased use of moxifloxacin is associated with an increase in fluoroquinolone resistance amongst gram negative uropathogens.</p> <p>Methods</p> <p>All antibiograms for Gram negative bacteria were obtained for 2000 to 2005. The defined daily dose (DDD) for each fluoroquinolone was computed according to World Health Organization criteria. To account for fluctuation in patient volume, DDD/1000 bed days was computed for each year of study. Association between DDD/1000 bed days for each fluoroquinolone and the susceptibility of Gram negative bacteria to ciprofloxacin was assessed using Pearson's Correlation Coefficient, r.</p> <p>Results</p> <p>During the study period, there were 48,261 antibiograms, 347,931 DDD of fluoroquinolones, and 1,943,338 bed days. Use of fluoroquinolones among inpatients decreased from 237.2 DDD/1000 bed days in 2000 to 115.2 DDD/1000 bed days in 2005. With the exception of <it>Enterobacter aerogenes</it>, moxifloxacin use was negatively correlated with sensitivity among all 13 Gram negative species evaluated (r = -0.07 to -0.97). When the sensitivities of all Gram negative organisms were aggregated, all fluoroquinolones except moxifloxacin were associated with increased sensitivity (r = 0.486 to 1.000) while moxifloxacin was associated with decreased sensitivity (r = -0.464).</p> <p>Conclusion</p> <p>Moxifloxacin, while indicated for empiric treatment of community acquired pneumonia, may have important negative influence on local antibiotic sensitivities amongst Gram negative organisms. This effect was not shared by other commonly used members of the fluoroquinolone class.</p

Does study duration have opposite effects on recognition and repetition priming?

We investigated whether manipulating the duration for which an item is studied has opposite effects on recognition memory and repetition priming, as has been reported by Voss and Gonsalves (2010). Robust evidence of this would support the idea that distinct explicit and implicit memory systems drive recognition and priming, and would constitute evidence against a single-system model (Berry, Shanks, Speekenbrink, & Henson, 2012). Across seven experiments using study durations ranging from 40 ms to 2250 ms, and two different priming tasks (a classification task in Experiments 1a, 2a, 3a, and 4, and a continuous identification with recognition (CID-R) task in Experiments 1b, 2b, and 3b), we found that although a longer study duration improved subsequent recognition in each experiment, there was either no detectable effect on priming (Experiments 1a, 2a, and 4) or a similar effect to that on recognition, albeit smaller in magnitude (Experiments 1b, 2b, 3a, and 3b). Our findings (1) question whether study duration has opposite effects on recognition and priming, and (2) are robustly consistent with a single-system model of recognition and priming

The role of spatial boundaries in shaping long-term event representations

When remembering the past, we typically recall ‘events’ that are bounded in time and space. However, as we navigate our environment our senses receive a continuous stream of information. How do we create discrete long-term episodic memories from continuous input? Although previous research has provided evidence for a role of spatial boundaries in the online segmentation of our sensory experience within working memory, it is not known how this segmentation contributes to subsequent long-term episodic memory. Here we show that the presence of a spatial boundary at encoding (a doorway between two rooms) impairs participants’ later ability to remember the order that objects were presented in. A sequence of two objects presented in the same room in a virtual reality environment is more accurately remembered than a sequence of two objects presented in adjoining rooms. The results are captured by a simple model in which items are associated to a context representation that changes gradually over time, and changes more rapidly when crossing a spatial boundary. We therefore provide the first evidence that the structure of long-term episodic memory is shaped by the presence of a spatial boundary and provide constraints on the nature of the interaction between working memory and long-term memory

An eye-movement study of relational memory in adults with Autism Spectrum Disorder

Persons with Autism Spectrum Disorder (ASD) demonstrate good memory for single items but difficulties remembering contextual information related to these items. Recently, we found compromised explicit but intact implicit retrieval of object-location information in ASD (Ring et al. 2015). Eye-movement data collected from a sub-sample of the participants are the focus of the current paper. At encoding, trial-by-trial viewing durations predicted subsequent retrieval success only in typically developing (TD) participants. During retrieval, TD compared to ASD participants looked significantly longer at previously studied objectlocations compared to alternative locations. These findings extend similar observations recently reported by Cooper et al. (2017a) and demonstrate that eye-movement data can shed important light on the source and nature of relational memory difficulties in ASD

LSST Science Book, Version 2.0

A survey that can cover the sky in optical bands over wide fields to faint magnitudes with a fast cadence will enable many of the exciting science opportunities of the next decade. The Large Synoptic Survey Telescope (LSST) will have an effective aperture of 6.7 meters and an imaging camera with field of view of 9.6 deg^2, and will be devoted to a ten-year imaging survey over 20,000 deg^2 south of +15 deg. Each pointing will be imaged 2000 times with fifteen second exposures in six broad bands from 0.35 to 1.1 microns, to a total point-source depth of r~27.5. The LSST Science Book describes the basic parameters of the LSST hardware, software, and observing plans. The book discusses educational and outreach opportunities, then goes on to describe a broad range of science that LSST will revolutionize: mapping the inner and outer Solar System, stellar populations in the Milky Way and nearby galaxies, the structure of the Milky Way disk and halo and other objects in the Local Volume, transient and variable objects both at low and high redshift, and the properties of normal and active galaxies at low and high redshift. It then turns to far-field cosmological topics, exploring properties of supernovae to z~1, strong and weak lensing, the large-scale distribution of galaxies and baryon oscillations, and how these different probes may be combined to constrain cosmological models and the physics of dark energy.Comment: 596 pages. Also available at full resolution at http://www.lsst.org/lsst/sciboo