The enduring impact of one-session exposure treatment on selective processing bias and explicit memory avoidance in snake- and spider-fearful participants

The prevalence of anxiety disorders in the general population makes clarification of variables that contribute to the onset or maintenance of these disorders essential. Two such contributory variables are anxiety-induced selective processing bias and theorized subsequent explicit memory avoidance. The purpose of the present study was to examine the impact of one-session in vivo exposure treatment on selective processing bias and explicit memory avoidance immediately following successful treatment of stimulus-specific anxiety as well as at one-week and one-month follow-up. Participants (N = 60) were assigned to one of three groups: (1) the treatment group, composed of individuals who were fearful of either a snake or a spider and who received one-session in vivo exposure treatment for that fear; (2) the no-treatment group, composed of snake- or spider-fearful individuals who did not receive treatment for this specific fear; or (3) the control group, composed of individuals who were not fearful of either a snake or spider. Comparisons of these three participant groups occurred prior to treatment (i.e. pre-test assessment), following treatment (i.e. post-test assessment), and at one-week and one-month follow-up on tests of selective processing bias and on tests of explicit memory for a previously learned word list. It was hypothesized that treatment would cause immediate elimination of selective processing bias and explicit memory avoidance, but that the effects of treatment would reduce at one-week and one-month follow-up as no treatment maintenance procedures were used in this study. Mostly null results were obtained on all dependent variable measures used in this study at all assessment periods. This sample displayed no evidence of selective processing bias and/or explicit memory avoidance at any of the four assessment points, halting the investigation of the impact of treatment on these processes. Additionally, results pertaining to the impact of state and trait anxiety were largely null. Thus, all questions the study was to address could not be adequately answered given the lack of evidence for the presence of the constructs in the sample. Focus of the discussion is on the reasons for the null results, including methodological issues as well as theoretical issues with the constructs of interest

Electronic portfolios: Demonstrating student competence against external accreditation standards

The aim of this eScholar project was to evaluate the effectiveness of an electronic portfolio as a learning and professional development resource for clinical-based health professionals; in the first instance its use by nursing students was explored. Portfolios have been used in nursing practice as a repository of evidence against nursing standards since the 1990s. Early portfolios were paper based, whilst recent iterations have evolved into electronic portfolio formats. An iPortfolio, available to all students studying at Curtin University, was integrated into the clinical practice units within the Bachelor of Science (Nursing) program as a suitable adjunct to support student learning and assessment. A cross-sectional study was conducted in 2010, involving a convenience sample of 115 students in the first semester of their course. A questionnaire solicited data on demographics, information technology skills, iPortfolio use, its structure and function and impact on the learning process. The information technology skills required for iPortfolio use were met by the majority of the study population, despite some having irregular access to computers and the Internet. Some onerous iPortfolio functionalities limited the full application of the tool for demonstrating professional-based competencies; however its value was recognised by users. Using the tool supported learning processes, particularly reflective practice, gaining feedback and self-determination of learning capacity. The results suggest the iPortfolio has potential as an electronic learning and assessment tool. With minimal modifications, its affordances support the demonstration of a skill set and evidence display against Curtin’s graduate attributes and the Australian Nursing and Midwifery Council’s competencies

The effect of one-session exposure treatment on selective processing and explicit memory bias in snake- and spider-fearful participants

Unlike the empirically supported phenomenon of anxiety-induced selective processing bias, research on congruent explicit memory bias is inconclusive; indeed, there is evidence for recall decrements of threat-relevant information. There is also a paucity of literature examining the effects of treatment on these cognitive biases. Thus, the purpose of this study was to examine the effect of exposure treatment on selective processing and explicit memory bias in snake- and spider-fearful participants by measuring implicit and explicit memory for central and peripheral environmental details. Recall for environmental details in a fearful group that received treatment was compared to a fearful group that did not receive treatment and to a non-fearful control group to evaluate the presence of selective processing bias, explicit memory bias, and the effect of treatment on these phenomena. Results indicated no implicit or explicit memory biases in any participant group. There was, however, the presence of significant memory deficits, specifically for peripheral details, in fearful participants who did not receive treatment

Rivers in practice: clinicians' assessments of patients' decision-making capacity

Since the Rivers v. Katz decision in 1986, clinicians in New York State have been required to assess patient decision-making capacity before judicial review of petitions to administer involuntary medication. The authors examined 42 capacity assessments made by psychiatrists at a large state hospital in New York City. Although the capacity assessments were often incomplete and rarely addressed the treatment decision, most clinicians judged patients as lacking capacity to make treatment decisions. The findings suggest that psychiatrists may view capacity assessments as irrelevant because of the manifestly grave nature of patients' illnesses or may not differentiate the capacity assessment from the mental status examination. The capacity assessment may nonetheless be a useful tool because it encourages clinicians to discuss the proposed treatment with patients and to present information more effectively in court

Outcome of Involuntary Medication in a State Hospital System

Objective: The purpose of the study was to examine the course of involuntarily administered medication in a state hospital population. Method: The authors retrospectively examined the records of all 51 involuntarily medicated patients in six state hospitals in New York City in a single calendar year. Clinical course was recorded for the period of involuntary medication and for 12 months thereafter. These patients were compared to 51 patients on the same wards who accepted medication. Results: Clinicians assessed involuntarily medicated patients as more dangerous to themselves or others and less delusional after treatment than the comparison patients. Long-acting intramuscular antipsychotics were prescribed more frequently for involuntarily medicated patients. No differences were observed in rates of discharge, outpatient cooperation, or rehospitalization. Half of the patients in both groups remained continuously institutionalized, and of those who left the hospital, only 30% of the involuntarily medicated group and 40% of the comparison group took medication as outpatients. Conclusions: For these chronically severely ill patients, involuntary medication did not appear to enhance insight or cooperation or result in rapid return to the community. Involuntary medication is often a necessary short-term, in-hospital management strategy, but it does not replace the need to develop comprehensive, long-term inpatient and community-based approaches to the management of treatment refusal