Psychopathy is associated with fear-specific reductions in neural activity during affective perspective-taking.

Psychopathic individuals are notorious for their callous disregard for others' emotions. Prior research has linked psychopathy to deficits in affective mechanisms underlying empathy (e.g., affective sharing), yet research relating psychopathy to cognitive mechanisms underlying empathy (e.g., affective perspective-taking and Theory of Mind) requires further clarification. To elucidate the neurobiology of cognitive mechanisms of empathy in psychopathy, we administered an fMRI task and tested for global as well as emotion-specific deficits in affective perspective-taking. Adult male incarcerated offenders (N = 94) viewed images of two people interacting, with one individual's face obscured by a shape. Participants were cued to either identify the emotion of the obscured individual or identify the shape from one of two emotion or shape choices presented on each trial. Target emotions included anger, fear, happiness, sadness, and neutral. Contrary to predictions, psychopathy was unrelated to neural activity in the Affective Perspective-taking > Shape contrast. In line with predictions, psychopathy was negatively related to task accuracy during affective perspective-taking for fear, happiness, and sadness. Psychopathy was related to reduced hemodynamic activity exclusively during fear perspective-taking in several areas: left anterior insula extending into posterior orbitofrontal cortex, right precuneus, left superior parietal lobule, and left superior occipital cortex. Although much prior research has emphasized psychopathy-related abnormalities in affective mechanisms mediating empathy, current results add to growing evidence of psychopathy-related abnormalities in a cognitive mechanism related to empathy. These findings highlight brain regions that are hypoactive in psychopathy when explicitly processing another's fear.

Witnessing domestic violence during childhood is associated with psychopathic traits in adult male criminal offenders.

While there is growing evidence that suffering physical abuse during childhood is subsequently associated with psychopathic traits in both juvenile and adult offenders, there is considerably less research on whether exposure to domestic violence as a witness, rather than as a direct victim, influences the subsequent presentation of psychopathic traits in adulthood. Accordingly, the current study examined the relationship between witnessing domestic violence during childhood (i.e., witnessing, hearing, or intervening in abuse against a parent/sibling) and psychopathic traits in adulthood in a sample of n = 127 incarcerated male offenders. As predicted, witnessing domestic violence was significantly associated with overall level of psychopathy, with a particularly strong relationship to the interpersonal/affective features of psychopathy. Importantly, this relationship held when controlling for the experience of domestic violence as a direct victim. These results add to the growing body of literature linking adverse and traumatic events during childhood with psychopathic traits later in life, and suggest that domestic violence exposure may be one factor contributing to the manipulative, interpersonal style exhibited by individuals high in psychopathy. (PsycINFO Database Record

Efficacy of a Mobile App-Based Intervention for Young Adults With Anxiety Disorders: A Randomized Clinical Trial.

Importance: Anxiety disorders are prevalent and undertreated among young adults. Digital mental health interventions for anxiety are promising but limited by a narrow range of therapeutic components and low user engagement. Objective: To investigate the efficacy of and engagement with Maya, a scalable, self-guided, comprehensive mobile cognitive behavioral therapy (CBT) intervention with embedded engagement features, comparing the effects of 3 incentive conditions. Design, Setting, and Participants: This randomized clinical trial recruited young adults aged 18 to 25 years with anxiety disorders through online advertisements and outpatient psychiatry clinics at Weill Cornell Medicine. Enrollment was between June 16, 2021, and November 11, 2022. Data analysis was performed from December 21, 2022, to June 14, 2024. Intervention: Participants received a 6-week program of the intervention and were randomized to 1 of 3 different text message-based incentive conditions (gain-framed, loss-framed, or gain-social support). Main Outcomes and Measures: The primary outcome was change in anxious symptoms from baseline to end of treatment, as measured by the Hamilton Anxiety Rating Scale (HAM-A). The Anxiety Sensitivity Index and the Leibowitz Social Anxiety Scale scores were secondary measures. Results: The sample consisted of 59 participants (mean [SD] age, 23.1 [1.9] years; 46 [78%] female; 22 [37%] Asian, 3 [5%] Black, 5 [8%] Hispanic or Latino, 1 [2%] American Indian or Alaska Native, 25 [42%] White, and 6 [10%] >1 race; 32 [54%] college-educated and 12 [20%] graduate or professional school-educated; mean [SD] baseline HAM-A score, 15.0 [6.5]). Anxiety, measured by HAM-A, decreased across conditions from baseline to end of the intervention (mean difference, -5.64; 95% CI, -7.23 to -4.05), and symptomatic improvement was maintained at the week 12 follow-up (baseline to follow-up mean difference, -5.67; 95% CI, -7.29 to -4.04). However, there was no evidence that change in anxiety differed by incentive condition (loss-framed vs gain-social support mean difference, -1.40; 95% CI, -4.72 to 1.93; gain-framed vs gain-social support mean difference, 1.38; 95% CI, -1.19 to 3.96). Secondary anxiety measures (Anxiety Sensitivity Index and Liebowitz Social Anxiety Scale scores) showed a similar pattern of improvement, with no evidence of differences between incentive conditions. Participants completed most of the 12 sessions (mean [SD], 10.8 [2.1]; 95% CI, 10.3-11.4), and User Mobile Application Rating Scale app quality ratings exceeded the published threshold for acceptability at all study visits. There was no evidence that either session completion or app quality ratings differed by incentive condition. Conclusions and Relevance: In this randomized clinical trial of an app-based intervention for anxiety, the primary hypothesis that improvement in anxiety would be greatest in the condition using gain of points plus social incentives was not supported; however, the results suggest that a CBT application incorporating a full suite of CBT skills and embedded user engagement features was efficacious in improving symptoms in young adults with anxiety disorders. Given these findings, digital interventions represent a promising step toward wider dissemination of high-quality, evidence-based interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT05130281.

Relevance of psychopathic traits to therapeutic processes and outcomes for veterans with substance use disorders.

Psychopathic traits have been routinely associated with poor treatment outcomes in correctional settings. Less is known about how psychopathic traits relate to treatment processes (e.g., perceptions of treatment; adjustment to treatment), particularly in nonforensic settings. The current study tested for relationships between psychopathic traits, as operationalized by the Triarchic Psychopathy Measure (TriPM) and treatment processes and outcomes in a sample of 200 U.S. military veterans enrolled in a residential substance use disorder treatment program at a Veteran's Affairs (VA) medical center. Participants were interviewed using several measurement instruments at 4 time points: treatment entry, 1 month into treatment, treatment discharge, and 12 months post discharge. The TriPM was administered at baseline, and measures of treatment processes/outcomes were measured during treatment and at postdischarge. The TriPM scales exhibited differential associations with treatment processes and outcomes in multivariate analyses. Specifically, higher Boldness was associated with fewer psychiatric symptoms at baseline, but more rule-breaking behaviors and more peer-reported conflicts with other residents in treatment; higher Meanness predicted more negative perceptions of the treatment milieu; and higher Disinhibition predicted poorer substance use outcomes posttreatment. Together, these findings demonstrate associations between psychopathy and therapy processes/outcomes and highlight the potentially unique contribution of psychopathic traits to substance use disorder treatment programming. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Challenges Associated with Parenting While Incarcerated: A Review.

Of the 2.5 million people who are incarcerated in the United States, over half are parents. While it is well-established that incarceration has a detrimental impact on the children of incarcerated parents, less is known regarding the psychological impact of incarceration on parents themselves. The present review summarizes existing literature on the impact of incarceration on parents retrieved via online databases. Published articles were classified according to their overall themes and summarized. Pertinent studies include the psychological and emotional consequences of incarceration on parents, the experience of parenting while incarcerated, including barriers to parenting, the utility of parenting program interventions during periods of incarceration, and how these results differ for mothers and fathers. While the existing evidence introduces these issues, there is a need for additional research on the impact of incarceration on parents. These areas for future research as well as clinical implications are discussed.

The CopeNYP program: A model for brief treatment of psychological distress among healthcare workers and hospital staff.

In the midst of the Spring 2020 initial surge of the COVID-19 pandemic in New York, members of the Psychiatry Department of Weill Cornell Medicine/NewYork-Presbyterian Hospital rapidly created and implemented a brief, behavioral skills-based intervention program, "CopeNYP", to address the immediate mental health needs of the employees of the hospital and medical school. We describe the development, implementation and evolution of this telehealth-delivered program staffed primarily by in-house clinical psychologists, postdoctoral fellows, pre-doctoral interns and counselors who were redeployed or volunteered their time to provide urgent support for employees. We discuss the challenges and lessons learned in providing brief, skills-based psychological interventions for employees subjected to chronic stress. As the impact of the pandemic became prolonged, employees faced compounding stressors including social isolation, fear of infection, grief and loss, and sequelae of COVID-19-related illness combined with work-related demands. Our goal is to present our program design, implementation, and utilization as a blueprint for other institutions that would like to develop an evidence-based clinician-staffed psychological intervention program to support ongoing employee mental health needs.

Development of an expert-rater assessment of trauma history in a high-risk youth forensic sample.

OBJECTIVE: Exposure to childhood trauma is particularly prevalent among incarcerated juveniles. Although there is a growing understanding of the detrimental impact trauma exposure can have on child and adolescent development, childhood maltreatment can be very difficult to accurately measure. Integration of self-report trauma histories as well as supplemental file reports of trauma exposure may provide the most accurate estimate of experienced trauma among youth in correctional settings. METHOD: The current study developed an expert-rated assessment of trauma that synthesizes self-report, as well as objective file information, using a sample of 114 incarcerated male juveniles. RESULTS: In addition to establishing scale factor structure, reliability, and validity, the current study provides additional evidence of the prevalence of trauma among incarcerated juveniles and reports on external correlates of the scale that are particularly relevant in correctional settings (e.g., psychopathic traits). CONCLUSION: These results suggest that the integration of both self-report and file material can be meaningfully used to assess traumatic symptomology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Two subtypes of psychopathic criminals differ in negative affect and history of childhood abuse.

OBJECTIVE: Specification of the etiological mechanisms underlying psychopathy is a key step in developing more effective methods for preventing and remediating the callous and impulsive behavior that characterizes the disorder. Theoretical conceptualizations of psychopathic subtypes propose that a primary variant largely stems from impoverished affect, whereas a secondary variant is hypothesized to develop subsequent to adverse environmental experiences (e.g., childhood maltreatment). However, there has been a dearth of research demonstrating that psychopathic subtypes actually differ in terms of experienced childhood maltreatment in an adult offender population. METHOD: The current study employed model-based cluster analysis (MBCA) in a sample of incarcerated, psychopathic males (n = 110) to identify subtypes of psychopathic offenders based on a broad personality assessment. RESULTS: Two subgroups emerged: 1 with high levels of negative affect (high-NA) and 1 with low levels of negative affect (low-NA). The high-NA subgroup scored significantly higher on measures of childhood maltreatment. CONCLUSION: These results provide support for theoretical conceptualizations of psychopathic subtypes, suggesting that psychopathic offenders with high levels of negative affect experience a greater degree of childhood maltreatment. (PsycINFO Database Record

Psychopathic traits are associated with reduced fixations to the eye region of fearful faces.

Impairments in processing fearful faces have been documented in both children and adults with psychopathic traits, suggesting a potential mechanism by which psychopathic individuals develop callous and manipulative interpersonal and affective traits. Recently, research has demonstrated that psychopathic traits are associated with reduced fixations to the eye regions of faces in samples of children and community-dwelling adults, however this relationship has not yet been established in an offender sample with high levels of psychopathy. In the current study, we employed eye-tracking with paradigms involving the identification and passive viewing of facial expressions of emotion, respectively, in a sample of adult male criminal offenders (n = 108) to elucidate the relationship between visual processing of fearful facial expressions and interpersonal and affective psychopathic traits. We found that the interpersonal-affective traits of psychopathy were significantly related to fewer fixations to the eyes of fear faces during the emotion recognition task. This association was driven particularly by the interpersonal psychopathic traits (e.g., egocentricity, deceitfulness), whereas fear recognition accuracy was inversely related to the affective psychopathic traits (e.g., callousness, lack of empathy). These findings highlight potential mechanisms for the subset of the interpersonal-affective traits exhibited by psychopathic individuals. (PsycINFO Database Record

Psychopathic traits linked to alterations in neural activity during personality judgments of self and others.

Psychopathic individuals are notorious for their grandiose sense of self-worth and disregard for the welfare of others. One potential psychological mechanism underlying these traits is the relative consideration of "self" versus "others". Here we used task-based functional magnetic resonance imaging (fMRI) to identify neural responses during personality trait judgments about oneself and a familiar other in a sample of adult male incarcerated offenders (n = 57). Neural activity was regressed on two clusters of psychopathic traits: Factor 1 (e.g., egocentricity and lack of empathy) and Factor 2 (e.g., impulsivity and irresponsibility). Contrary to our hypotheses, Factor 1 scores were not significantly related to neural activity during self- or other-judgments. However, Factor 2 traits were associated with diminished activation to self-judgments, in relation to other-judgments, in bilateral posterior cingulate cortex and right temporoparietal junction. These findings highlight cortical regions associated with a dimension of social-affective cognition that may underlie psychopathic individuals' impulsive traits.

Reversal learning deficits in criminal offenders: Effects of psychopathy, substance use, and childhood maltreatment history.

Deficits in reinforcement learning are presumed to underlie the impulsive and incorrigible behavior exhibited by psychopathic criminals. However, previous studies documenting reversal learning impairments in psychopathic individuals have not investigated this relationship across a continuous range of psychopathy severity, nor have they examined how reversal learning impairments relate to different psychopathic traits, such as the interpersonal-affective and lifestyle-antisocial dimensions. Furthermore, previous studies have not considered the role that childhood maltreatment and substance use may have in this specific cognitive deficit. Using a standard reversal learning task in a sample of N = 114 incarcerated male offenders, we demonstrate a significant relationship between psychopathy severity and reversal learning errors. Furthermore, we show a significant interaction between psychopathy and childhood maltreatment, but not substance use, such that individuals high in psychopathy with an extensive history of maltreatment committed the greatest number of reversal learning errors. These findings extend the current understanding of reversal learning performance among psychopathic individuals, and highlight the importance of considering childhood maltreatment when studying psychopathy.

Clarifying the link between childhood abuse history and psychopathic traits in adult criminal offenders.

Childhood abuse is a risk factor for the development of externalizing characteristics and disorders, including antisocial personality disorder and psychopathy. However, the precise relationships between particular types of childhood maltreatment and subsequent antisocial and psychopathic traits remain unclear. Using a large sample of incarcerated adult male criminal offenders (n = 183), the current study confirmed that severity of overall childhood maltreatment was linked to severity of both psychopathy and antisocial personality disorder in adulthood. Moreover, this relationship was particularly strong for physical abuse and the antisocial facet of psychopathy. Sexual abuse history was uniquely related to juvenile conduct disorder severity, rather than adult psychopathy or antisocial behaviors. Additionally, there was a significantly stronger relationship between childhood maltreatment and juvenile conduct disorder than between childhood maltreatment and ASPD or psychopathy. These findings bolster and clarify the link between childhood maltreatment and antisocial behavior later in life. (PsycINFO Database Record