5 results
4 Initial Application of Constraint-Induced Cognitive Therapy to Long COVID Brain Fog
- Gitendra Uswatte, Edward Taub, Karlene Ball, Kristine Lokken, Shruti P Agnihotri, Victor W Mark, Amy Knight, Brandon Mitchell, Jason Blake, Staci McKay, Terika Miller, Elizabeth Pollard, Piper Hempfling, Morgan Smith, Rebekah Chatfield, Erin Stanley, Cliff Lynam, Kyli Blagburn, Brooke Carroll, Gary Cutter
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 598-599
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Persistent brain fog is common in adults with Post-Acute Sequelae of SARS-CoV-2 infection (PASC), in whom it causes distress and in many cases interferes with performance of instrumental activities of daily living (IADL) and return-to-work. There are no interventions with rigorous evidence of efficacy for this new, often disabling condition. The purpose of this pilot is to evaluate the efficacy, on a preliminary basis, of a new intervention for this condition termed Constraint-Induced Cognitive therapy (CICT). CICT combines features of two established therapeutic approaches: cognitive speed of processing training (SOPT) developed by the laboratory of K. Ball and the Transfer Package and task-oriented training components of Constraint-Induced Movement therapy developed by the laboratory of E. Taub and G. Uswatte.
Participants and Methods:Participants were > 3 months after recovery from acute COVID symptoms and had substantial brain fog and impairment in IADL. Participants were randomized to CICT immediately or after a 3-month delay. CICT involved 36 hours of outpatient therapy distributed over 4-6 weeks. Sessions had three components: (a) videogamelike training designed to improve how quickly participants process sensory input (SOPT), (b) training on IADLs following shaping principles, and (c) a set of behavioral techniques designed to transfer gains from the treatment setting to daily life, i.e., the Transfer Package. The Transfer Package included (a) negotiating a behavioral contract with participants and one or more family members about the responsibilities of the participants, family members, and treatment team; (b) assigning homework during and after the treatment period; (c) monitoring participants’ out-of-session behavior; (d) supporting problem-solving by participants and family members about barriers to performance of IADL; and (e) making follow-up phone calls. IADL performance, brain fog severity, and cognitive impairment were assessed using validated, trans-diagnostic measures before and after treatment and three months afterwards in the immediate-CICT group and on parallel occasions in the delayed-CICT group (aka waitlist controls).
Results:To date, five were enrolled in the immediate-CICT group; four were enrolled in the wait-list group. All had mild cognitive impairment, except for one with moderate impairment in the immediate-CICT group. Immediate-CICT participants, on average, had large reductions in brain fog severity on the Mental Clutter Scale (MCS, range = 0 to 10 points, mean change = -3.7, SD = 2.0); wait-list participants had small increases (mean change = 1.0, SD = 1.4). Notably, all five in the immediate-CICT group had clinically meaningful improvements (i.e., changes > 2 points) in performance of IADL outside the treatment setting as measured by the Canadian Occupational Performance Measure (COPM) Performance scale; only one did in the wait-list group. The advantage for the immediate-CICT group was very large on both the MCS and COPM (d’s = 1.7, p’s < .05). In follow-up, immediate-CICT group gains were retained or built-upon.
Conclusions:These preliminary findings warrant confirmation by a large-scale randomized controlled trial. To date, CICT shows high promise as an efficacious therapy for brain fog due to PASC. CICT participants had large, meaningful improvements in IADL performance outside the treatment setting, in addition to large reductions in brain fog severity.
A practical risk calculator for suicidal behavior among transitioning U.S. Army soldiers: results from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS)
- Jaclyn C. Kearns, Emily R. Edwards, Erin P. Finley, Joseph C. Geraci, Sarah M. Gildea, Marianne Goodman, Irving Hwang, Chris J. Kennedy, Andrew J. King, Alex Luedtke, Brian P. Marx, Maria V. Petukhova, Nancy A. Sampson, Richard W. Seim, Ian H. Stanley, Murray B. Stein, Robert J. Ursano, Ronald C. Kessler
-
- Journal:
- Psychological Medicine / Volume 53 / Issue 15 / November 2023
- Published online by Cambridge University Press:
- 09 March 2023, pp. 7096-7105
-
- Article
- Export citation
-
Background
Risk of suicide-related behaviors is elevated among military personnel transitioning to civilian life. An earlier report showed that high-risk U.S. Army soldiers could be identified shortly before this transition with a machine learning model that included predictors from administrative systems, self-report surveys, and geospatial data. Based on this result, a Veterans Affairs and Army initiative was launched to evaluate a suicide-prevention intervention for high-risk transitioning soldiers. To make targeting practical, though, a streamlined model and risk calculator were needed that used only a short series of self-report survey questions.
MethodsWe revised the original model in a sample of n = 8335 observations from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS) who participated in one of three Army STARRS 2011–2014 baseline surveys while in service and in one or more subsequent panel surveys (LS1: 2016–2018, LS2: 2018–2019) after leaving service. We trained ensemble machine learning models with constrained numbers of item-level survey predictors in a 70% training sample. The outcome was self-reported post-transition suicide attempts (SA). The models were validated in the 30% test sample.
ResultsTwelve-month post-transition SA prevalence was 1.0% (s.e. = 0.1). The best constrained model, with only 17 predictors, had a test sample ROC-AUC of 0.85 (s.e. = 0.03). The 10–30% of respondents with the highest predicted risk included 44.9–92.5% of 12-month SAs.
ConclusionsAn accurate SA risk calculator based on a short self-report survey can target transitioning soldiers shortly before leaving service for intervention to prevent post-transition SA.
Improving the prospective prediction of a near-term suicide attempt in veterans at risk for suicide, using a go/no-go task
- Catherine E. Myers, Chintan V. Dave, Michael Callahan, Megan S. Chesin, John G. Keilp, Kevin D. Beck, Lisa A. Brenner, Marianne S. Goodman, Erin A. Hazlett, Alexander B. Niculescu, Lauren St. Hill, Anna Kline, Barbara H. Stanley, Alejandro Interian
-
- Journal:
- Psychological Medicine / Volume 53 / Issue 9 / July 2023
- Published online by Cambridge University Press:
- 28 July 2022, pp. 4245-4254
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background
Neurocognitive testing may advance the goal of predicting near-term suicide risk. The current study examined whether performance on a Go/No-go (GNG) task, and computational modeling to extract latent cognitive variables, could enhance prediction of suicide attempts within next 90 days, among individuals at high-risk for suicide.
Method136 Veterans at high-risk for suicide previously completed a computer-based GNG task requiring rapid responding (Go) to target stimuli, while withholding responses (No-go) to infrequent foil stimuli; behavioral variables included false alarms to foils (failure to inhibit) and missed responses to targets. We conducted a secondary analysis of these data, with outcomes defined as actual suicide attempt (ASA), other suicide-related event (OtherSE) such as interrupted/aborted attempt or preparatory behavior, or neither (noSE), within 90-days after GNG testing, to examine whether GNG variables could improve ASA prediction over standard clinical variables. A computational model (linear ballistic accumulator, LBA) was also applied, to elucidate cognitive mechanisms underlying group differences.
ResultsOn GNG, increased miss rate selectively predicted ASA, while increased false alarm rate predicted OtherSE (without ASA) within the 90-day follow-up window. In LBA modeling, ASA (but not OtherSE) was associated with decreases in decisional efficiency to targets, suggesting differences in the evidence accumulation process were specifically associated with upcoming ASA.
ConclusionsThese findings suggest that GNG may improve prediction of near-term suicide risk, with distinct behavioral patterns in those who will attempt suicide within the next 90 days. Computational modeling suggests qualitative differences in cognition in individuals at near-term risk of suicide attempt.
Genetic liability to schizophrenia is associated with exposure to traumatic events in childhood
- Hannah M. Sallis, Jazz Croft, Alexandra Havdahl, Hannah J. Jones, Erin C. Dunn, George Davey Smith, Stanley Zammit, Marcus R. Munafò
-
- Journal:
- Psychological Medicine / Volume 51 / Issue 11 / August 2021
- Published online by Cambridge University Press:
- 01 April 2020, pp. 1814-1821
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background
There is a wealth of literature on the observed association between childhood trauma and psychotic illness. However, the relationship between childhood trauma and psychosis is complex and could be explained, in part, by gene–environment correlation.
MethodsThe association between schizophrenia polygenic scores (PGS) and experiencing childhood trauma was investigated using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and the Norwegian Mother, Father and Child Cohort Study (MoBa). Schizophrenia PGS were derived in each cohort for children, mothers, and fathers where genetic data were available. Measures of trauma exposure were derived based on data collected throughout childhood and adolescence (0–17 years; ALSPAC) and at age 8 years (MoBa).
ResultsWithin ALSPAC, we found a positive association between schizophrenia PGS and exposure to trauma across childhood and adolescence; effect sizes were consistent for both child or maternal PGS. We found evidence of an association between the schizophrenia PGS and the majority of trauma subtypes investigated, with the exception of bullying. These results were comparable with those of MoBa. Within ALSPAC, genetic liability to a range of additional psychiatric traits was also associated with a greater trauma exposure.
ConclusionsResults from two international birth cohorts indicate that genetic liability for a range of psychiatric traits is associated with experiencing childhood trauma. Genome-wide association study of psychiatric phenotypes may also reflect risk factors for these phenotypes. Our findings also suggest that youth at higher genetic risk might require greater resources/support to ensure they grow-up in a healthy environment.
14 - Terrorism, anxiety, and war
- Edited by Werner G. K. Stritzke, University of Western Australia, Perth, Stephan Lewandowsky, University of Western Australia, Perth, David Denemark, University of Western Australia, Perth, Joseph Clare, University of Western Australia, Perth, Frank Morgan, University of Western Australia, Perth
-
- Book:
- Terrorism and Torture
- Published online:
- 15 September 2009
- Print publication:
- 18 June 2009, pp 290-312
-
- Chapter
- Export citation
-
Summary
Psychological reactions to terrorism are a central ingredient in any terrorist act (Crenshaw, 1986). One of terrorists' major goals is typically to instill anxiety in a target population in order to pressure political elites to negotiate (Friedland and Merari, 1985; Long, 1990). As noted by Long (1990), terrorists often “use the unreasonable fear and the resulting political disaffection it has generated among the public to intimidate governments into making political concessions in line with [their] political goals” (p. 5). In research on reactions to the September 11 terrorist attacks, we find that anxiety undermines support for an aggressive foreign policy, reinforcing the political importance of anxious reactions to terrorism (Huddy et al., 2005, 2007). In light of these findings, it appears that terrorists have a good grasp of psychological reality.
Anxiety is thus a critical component of public reactions to terrorism. Its documented ability to undercut support for aggressive overseas anti-terrorism policies is at odds, however, with the conventional notion that governments arouse anxiety precisely to increase support for overseas military action (Mueller, 2007; see also Pyszczynski et al., this volume). Indeed, the Bush administration in the United States and the Howard government in Australia have both been consistently accused of engineering support for the war in Iraq through the use of fear-mongering tactics such as terror emergency alert systems and high-profile arrests and deportations of Muslim immigrants.