The Scarier The Better: Maximizing Exposure Therapy Outcomes For Spider Fear

Background: While exposure therapy effectively reduces anxiety associated with specific phobias, not all individuals respond to treatment and some will experience a return of fear after treatment ceases. Aims: This study aimed to test the potential benefit of increasing the intensity of exposure therapy by adding an extra step that challenged uncontrollability (Step 15: allowing a spider to walk freely over one\u27s body) to the standard fear hierarchy. Method: Fifty-one participants who had a severe fear of spiders completed two 60-min exposure sessions 1 week apart in a context that was either the same or different from the baseline and follow-up assessment context. Participants were categorized into groups based on the last hierarchy step they completed during treatment (Step 14 or fewer, or Step 15). Results: Those who completed Step 15 had greater reductions in fear and beliefs about the probability of harm from baseline to post-treatment than those who completed fewer steps. Although completing Step 15 did not prevent fear from returning after a context change, it allowed people to maintain their ability to tolerate their fear, which earlier steps did not. Despite some fear returning after a context change, individuals who completed Step 15 tended to report greater reductions in fear from baseline to the follow-up assessment than participants who completed 14 or fewer steps. Conclusions: Overall, these results suggest that more intensive exposure that directly challenges harm beliefs may lead to greater changes in fear and fear beliefs than less intensive exposure

The Association Between Alcohol Consumption, Lifetime Alcohol Use Disorder, And Psychiatric Distress Among Male And Female Veterans

Objective: This study aimed to examine among veterans (a) whether alcohol consumption patterns are associated with probability of psychiatric symptoms and (b) whether an alcohol use disorder (AUD) history explains psychiatric symptoms among nondrinkers. Method: Data were collected from 3,003 veterans (20.5% women). Genderstratified logistic models examined the association between alcohol consumption pattern and the odds of symptoms of posttraumatic stress disorder (PTSD), depression, and suicidality. Two types of models were tested: four-group models comparing moderate drinkers to nondrinkers, light, and heavy drinkers; and five-group models separating nondrinkers by AUD history. Results: In four-group models for both genders, compared with moderate drinkers, hazardous drinkers were more likely to have psychiatric symptoms. Among men, nondrinkers were more likely to have symptoms of depression and suicidality but not PTSD. Among women, nondrinkers and light drinkers were more likely to have PTSD symptoms. In the five-group model for men, odds of symptoms were higher for nondrinkers with an AUD history and hazardous drinkers. Compared to nondrinkers without an AUD history and light drinkers, male nondrinkers with an AUD history had higher odds of psychiatric symptoms. In the five-group model for women, the odds of symptoms were higher for hazardous drinkers. Female nondrinkers with an AUD history had higher odds of a positive depression screen. Odds of a positive PTSD screen were higher for female nondrinkers (with and without an AUD history) and light drinkers. Conclusions: For male veterans, there was a protective effect of moderate drinking (compared with abstinence) that disappeared when nondrinkers without an AUD history were separated. However, results for women showed a protective effect of moderate drinking with regard to PTSD that persisted even when an AUD history was taken into account

Psychometric Validation Of The Anticipated Effects Of Alcohol Mixed With Energy Drinks Scale

Young people are increasingly consuming alcohol mixed with energy drinks (AmEDs). As coingestion of these beverages results in greater adverse consequences than from drinking alcohol alone, we need to understand what factors contribute to and deter coingestion. Existing studies in this area have not utilized a theoretically based or empirically validated measure of outcome expectancies for drinking AmEDs. Our study modified Morean, Corbin, and Treat\u27s (2012) Anticipated Effects of Alcohol Scale to assess the expected effects of drinking AmEDs. We evaluated the factor structure and concurrent validity of the Anticipated Effects of Alcohol Mixed with Energy Drinks (AEAMEDS) among 549 university students, aged 18-25, who had a lifetime history of consuming alcohol (231 had consumed AmEDs in the past 90 days). Exploratory and confirmatory factor analysis supported a 4-factor structure. Consistent with hypotheses, stronger high arousal/positive expectancies and weaker low arousal/negative expectancies were associated with greater AmED use. At the bivariate level, stronger low arousal/positive expectancies were associated with greater quantities of AmED use, but this relationship disappeared when taking into account other outcome expectancies. Moreover, students expected low arousal/positive expectancies to be less intense when consuming AmEDs than alcohol alone, but ratings for all other AmED expectancies were equivalent to consuming alcohol alone. These findings contribute to our knowledge of risk and protective factors for AmED use

Contingency Management Versus Psychotherapy For Prenatal Smoking Cessation: A Meta-Analysis Of Randomized Controlled Trials

Objectives: Prenatal smoking is the leading preventable cause of poor obstetric outcomes, yet treatment options are limited. Past reviews of prenatal smoking cessation have often grouped all counseling into a single category, which ignores the fact that psychotherapy is distinct from brief counseling. The objective of this study was to compare the effect sizes of two intensive interventions for prenatal smoking cessation: contingency management (i.e., financial incentives for abstinence) and psychotherapy. Methods: A systematic search for randomized controlled trials testing the efficacy of contingency management or psychotherapy was completed using PubMed, PsycINFO, Web of Science, the Cochrane Library, and EMBASE. Independent raters extracted data and assessed trials for risk of bias. Treatment effects were analyzed for three times points: late pregnancy, early postpartum, and late postpartum. Results: The search yielded 22 studies, and meta-analytic results indicated that interventions (compared with control groups) generally increased the odds of abstinence. Moderator analyses indicated that intervention type (contingency management vs. psychotherapy) accounted for variability in effect sizes. When comparing treatment type, effects of contingency management interventions were significantly greater than those of psychotherapeutic interventions. Although psychotherapy did not affect smoking abstinence, contingency management interventions had significant treatment effects at all three time points. Conclusions: Contingency management seems to be a safe and efficacious prenatal smoking cessation treatment. Although psychotherapy alone did not show an effect on prenatal smoking abstinence, future research may seek to combine this approach with contingency management to promote prenatal smoking cessation