Integrating Religion and Spirituality into Psychiatric Outpatient Treatment in the United States.

It is common for mental health clients to desire that religion and spirituality (RS) be integrated into their treatment. Despite this preference, clients' RS beliefs often go overlooked in therapy for a variety of reasons including lack of provider training on integration, fear of causing offense, or concerns about wrongly influencing clients. The present study assessed the effectiveness of using a psychospiritual therapeutic curriculum to integrate RS into psychiatric outpatient treatment for highly religious clients (n = 150) seeking services through a faith-based clinic. The curriculum was well accepted by both clinicians and clients, and a comparison of clinical assessments administered at intake and program exit (clients averaged 6.5 months in the program) showed significant improvement across a broad range of psychiatric symptoms. These results suggest the use of a religiously integrated curriculum within a broader psychiatric treatment program is beneficial and may be a way to overcome clinicians' RS concerns and shortcomings while meeting religious clients' desires for inclusion.

Manage Emotions to Reduce Aggression: A Pilot Study of a Brief Treatment to Help Veterans Reduce Impulsive Aggression.

Veterans with posttraumatic stress disorder (PTSD) report more aggression than civilians with PTSD. Because emotion regulation difficulties mediated the relationship between PTSD symptoms and impulsive aggression in veterans, we developed an intervention to increase emotion regulation skills. This pilot study tested the feasibility and acceptability of a three-session treatment, Manage Emotions to Reduce Aggression (MERA), and examined its effectiveness at reducing aggression and emotion dysregulation. Male combat veterans with PTSD and impulsive aggression completed assessments before and 4 weeks after MERA. Overt Aggression Scale measured frequency of aggression; Difficulties in Emotion Regulation Scale assessed emotion dysregulation. Most veterans (95%) who completed MERA and the posttreatment assessment (n = 20) reported MERA was helpful. Veterans in the intent-to-treat sample demonstrated a significant decrease in their frequency of aggression (Cohen's d = -0.55) and emotion dysregulation (Cohen's d = -0.55). MERA may be an innovative treatment that helps veterans reduce aggression.

Heightened early-attentional stimulus orienting and impulsive action in men with antisocial personality disorder.

We tested whether enhanced stimulus orienting operationalized as N1 and P2 auditory evoked potentials to increasing loudness (50-90 dB clicks) could be associated with trait impulsivity (Barratt Impulsiveness Scale, BIS-11), impulsive action (commission error on the Immediate Memory Task), or impulsive choice (immediate responses on temporal discounting tasks). We measured N1 and P2 loudness sensitivity in a passive listening task as linear intensity-sensitivity slopes in 36 men with antisocial personality disorder with a history of conviction for criminal conduct and 16 healthy control men. Across all subjects, regression analyses revealed that a steeper P2 slope predicted higher IMT commission error/correct detection ratio, and lower stimulus discriminability (A-prime). These associations were also found within both groups. These relationships suggest an association between enhanced early stimulus orienting (P2), impulsive action (response inhibition), and impaired signal-noise discriminability (A-prime).

P3a amplitude predicts successful treatment program completion in substance-dependent individuals.

This study examined P3a amplitude as a direct predictor of treatment success for substance dependence. Participants were 35 adults (27 men, 8 women) undergoing treatment for substance dependence at an urban residential treatment facility between October 2005 and July 2007. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria were used to confirm substance dependence. P3a amplitude was significantly smaller for those who dropped out of treatment. Discriminant function analysis confirmed that P3a amplitude was a robust predictor of treatment completion, more sensitive than other measures including substance abuse severity. Implications for the interpretation of P3a amplitude as an index of executive function are discussed.

High psychopathic trait females exhibit reduced startle potentiation and increased p3 amplitude.

While there has been steady progress in identifying psychophysiological traits associated with psychopathy, most of the existing research has been carried out using incarcerated male participants, and data that include females are particularly rare. This study examined both affective startle blink modulation and P3 amplitude in a sample of female undergraduates grouped by scores on the Psychopathic Personality Inventory-Revised (PPI-R). Those scoring high for psychopathic traits lacked startle blink potentiation and demonstrated larger P3 amplitudes during auditory and visual oddball tasks. These data support the generalizability of deficient startle potentiation to non-incarcerated females with psychopathic traits, and add to a growing body of literature suggesting that psychopathic traits are associated with distinctive information-processing characteristics as indexed by P3 amplitude.

Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders.

Primary impulsive aggression (PIA) can be implicated as a common factor that results in an arrest, disciplinary, and restraint measures during confinement, and criminal recidivism after release. Evidence suggests that anti-impulsive aggression agents (AIAAs) can diminish or prevent impulsive aggression even when occurring with personality pathology such as borderline or antisocial personality disorder (ASPD), common conditions in offender populations. A previous review identified agents that have been subjected to controlled drug trials of sufficient quality, and subsequently, a decisional algorithm was developed for selecting an AIAA for individuals with IA. This selection process began with the five agents that showed efficacy in two or more quality studies from the earlier review. Today, 8 years after the quality review study, the present authors undertook this follow-up literature review. The aims of the present review were to survey the literature to identify and assess: (1) drug trials of comparable quality published since the 2013 review, including trials of the previously identified AIAAs as well as trials of agents not included in the earlier review; (2) severity of aggressive outbursts; (3) the materiality of risks or side-effects that are associated with individual AIAAs as well as antipsychotic agents commonly used to control clinical aggression; (4) efficacy of these agents in special populations (e.g., females); and (5) cost and convenience of each agent. Improved pharmacotherapy of PIA by addressing risks, side effects and practicality as well as the efficacy of AIAAs, should promote the rehabilitation and reintegration of some pathologically aggressive offenders back into the community.

Association of P3 amplitude to treatment completion in substance dependent individuals.

Individuals with substance use disorders typically show reduced amplitudes of the P3 component of the evoked potential and high scores on impulsivity and aggression measures. The present study investigated the usefulness of P3 amplitude, addiction severity and impulsivity as predictors of treatment completion in substance dependence. Forty-four participants (8 women), between the ages of 19 and 61 years old, who met DSM-IV-TR Axis I substance/alcohol dependence criteria were recruited for the present study. All participants were currently residents at a local substance abuse facility receiving treatment and had been free of all drug toxicity for a minimum of 21 days. The P3 was evoked using a standard rotated-heads oddball paradigm. Significantly reduced P3 amplitude at Pz was found in patients who did not complete treatment compared to those who did. P3 amplitude at Pz elicited by target stimuli correctly identified 76.2% of those who did complete the treatment and 46.7% of those who did not.

Characterizing aggression and its association to anger and hostility among male veterans with post-traumatic stress disorder.

OBJECTIVES: The basis for the associations among anger, hostility, aggressive behavior, and post-traumatic stress disorder (PTSD) remains unclear. We suggest classifying aggressive behavior may elucidate the associations among these factors. On the basis of diagnostic and neurobiological similarities between impulsive aggression (IA) and PTSD, we proposed that IA was the predominant form of aggression in PTSD and that anger and hostility would not significantly predict PTSD when IA was also included as a predictor. METHODS: We used cross-sectional self-report data obtained from two samples of male veterans (N = 136). RESULTS: Over 70% of veterans with PTSD reported IA compared to 29% of those without PTSD. IA, not anger, hostility, or premeditated aggression significantly predicted a diagnosis of PTSD. CONCLUSIONS: Associations between anger and PTSD may be unique to individuals with IA, and considering impulsive and premeditated aggressors separately may account for the heterogeneity found within samples of aggressive veterans with PTSD.

Premeditated aggression is associated with serum cholesterol in abstinent drug and alcohol dependent men.

Relationships between aggressive subtypes and lipids were explored in 18 adult males undergoing treatment for substance dependence. A positive association was observed between a measure of premeditated aggression and total cholesterol. This was in contrast to an inverse association between lower cholesterol and higher impulsivity and anxiety.

Using a clinically aggressive sample to examine the association between impulsivity, executive functioning, and verbal learning and memory.

Impulsive behavior has been conceptualized from several vantage points including biological, sociological and psychological phenomenon. A comprehensive review of the empirical literature revealed that there is a paucity of research examining the association between working memory, executive functioning and impulsivity. A total sample of 170 aggressive outpatient participants was recruited for the study. Participants were administered a comprehensive neuropsychological battery. Principal components analysis of the 19 CVLT indices revealed five factors, accounting for 68% of the total variance. Results from the canonical correlation revealed one significant canonical variate with loadings from three CVLT factors (General Verbal Learning, Response Discrimination, and Proactive Interference), two executive functioning measures (Trail Making Test and Controlled Oral Word Association Test), and one impulsivity subscale (Attentional Impulsiveness). The findings of this study underscore the importance of memory functioning in determining impulsive aggressive behavior.

Comparison of impulsive and premeditated perpetrators of intimate partner violence.

Violence occurs in four to five million intimate relationships each year in the United States. Past research has investigated the concept of batterer subtypes based on the nature of the violent behavior. To extend this research, the present study used the Impulsive/Premeditated Aggression Scale (IPAS) along with a battery of relevant self-report measures in a sample of men (N = 113) convicted of domestic violence and court ordered into an intervention program. Batterers whose violence was classified as premeditated scored higher on psychopathic traits and a measure of treatment rejection. Batterers whose violence was classified as impulsive in nature reported a wider range of serious psychopathology. It is suggested that the use of a bimodal classification (Impulsive/Premeditated) in batterers may have significant clinical and legal policy implications.

Client Attitudes toward Integrating Religion and Spirituality in Mental Health Treatment: Scale Development and Client Responses.

This article describes the development, validation, and responses to the first administration of the Religious/Spiritually Integrated Practice Assessment Scale-Client Attitudes (RSIPAS-CA). A total of 1,047 U.S. adults responded to an online survey administered by Qualtrics, which included the RSIPAS-CA for secondary analysis. Of those, 245 indicated they were either current or former mental health clients and thus were asked to complete a 10-item instrument assessing clients' attitudes toward integrating religion and spirituality (RS) in mental health treatment. A confirmatory factor analysis showed the current sample's data approached an adequate fit, and the instrument's reliability was considered very good (α = .89). Descriptive analyses indicated that clients have mixed views regarding who should initiate the discussion of RS, but a majority responded favorably toward integrating RS in practice. The article ends with a general comparison between client responses to the current survey and clinical social workers' responses to the practitioners' RSIPAS. It also discusses implications for research based on the scale development and implications for practice and education, based on client preferences.

A test of the psychometric characteristics of the BIS-Brief among three groups of youth.

The Barratt Impulsiveness Scale (BIS-11) is the most widely administered trait impulsiveness questionnaire. Recently a shorter, unidimensional version of the instrument was developed for adults (BIS-Brief). While psychometric characteristics of the BIS-Brief support its use among adults, it also may be more appropriate for youth samples than the complete BIS-11 because it less burdensome and omits items about activities not usually encountered by children and adolescents. This article describes a test of psychometric characteristics of the BIS-Brief among youth. To measure a sufficiently wide range of scores, analyses were conducted based on secondary data analysis of data sets pooled from 3 distinct youth cohorts aged 10-17: healthy controls (Control; n = 356); those who had a family history of substance use disorder (FH+; n = 302); and psychiatric inpatients (Patients; n = 322). Model fit for the BIS-Brief was good but varied somewhat depending on the respondent cohort. There was a strong correlation between test and re-test BIS-Brief both within a single day and at 6 months, and also a strong correlation between BIS-Brief and BIS-11 scores. Concurrent validity was supported by correlation with questionnaire measures, which tended to be more robustly associated with BIS-Brief than behavioral measures. Both BIS-Brief and BIS-11 forms were similarly associated with other convergent measures. In conclusion, the BIS-Brief is a shorter version of the BIS-11 that reduces participant burden and with psychometric properties that support its use among youth populations. (PsycINFO Database Record

Characterizing aggressive behavior with the Impulsive/Premeditated Aggression Scale among adolescents with conduct disorder.

This study extends the use of the Impulsive/Premeditated Aggression Scale for subtyping aggressive behavior among adolescents with Conduct Disorder. Of the Conduct Disorder symptoms, aggression has the strongest prognostic and treatment implications. While aggression is a complex construct, convergent evidence supports a dichotomy of impulsive and premeditated aggressive subtypes that are qualitatively different from one another in terms of phenomenology and neurobiology. Previous attempts at measuring subtypes of aggression in children and adults are not clearly generalizable to adolescents. Sixty-six adolescents completed a questionnaire for characterizing aggression (Impulsive/Premeditated Aggression Scale), along with standard measures of personality and general functioning. Principal components analysis demonstrated two stable factors of aggression with good internal consistency and construct validity. Compared to the premeditated aggression factor, the impulsive aggression factor was associated with a broader range of personality, thought, emotional, and social problems. As in the adult and child literature, characterization of aggressive behavior into two subtypes appears to be relevant to understanding individual differences among adolescents with Conduct Disorder.

Characterizing aggressive behavior in a forensic population.

The concept of a dichotomous versus a continuous aggression model continues to be debated within the research literature. The Impulsive/Premeditated Aggression Scale (IPAS; M. S. Stanford, R. J. Houston, C. W. Mathias, et al., 2003) is a newly developed self-report instrument designed to classify an individual's aggressive behavior as predominantly premeditated or predominantly impulsive. The IPAS consists of 30-items that are scored on a 5-point Likert scale. This study used a nonrandom sample of convenience (N = 85) from a forensic state hospital. Principal-components analysis of the 30 items revealed 2 distinct factors (Impulsive and Premeditated Aggression), which accounted for 33% of the variance. The results of this study further validate the bimodal classification of aggression through its application to a forensic sample. The implications for general assessment, diagnosis, and treatment are discussed.

Clergy Perceptions of Sexual Assault Victimization.

Although congregants often turn to clergy for help in dealing with personal difficulties, including marital problems, substance abuse issues, and mental illness, survivors of sexual assault do not commonly turn to clergy for support or guidance. This study utilized a mixed-methods approach, online survey, and semi-structured interviews to determine how clergy perceive sexual assault victimization. The results of this study showed that more blame was assigned to the victim as the relationship with the perpetrator became closer, with the exception of marital rape. This study also found that hostile sexism was a predictor of negative attitudes toward rape victims.

Electrophysiological substrates of impulsiveness: potential effects on aggressive behavior.

Previous investigations attempting to examine impulsiveness as a personality construct are likely confounded with a high incidence of aggressive and antisocial behavior. The present study assessed electroencephalographic activity at rest and during photic stimulation in two groups: (1) an impulsive group (n=10) scoring high on the Barratt Impulsiveness Scale (BIS-11) and reporting no indication of impulsive aggressive behavior; and (2) a non-aggressive control group (n=14) scoring within the normal range on the BIS-11. All subjects completed a brief battery of personality measures related to impulsivity and aggression. Resting EEG was recorded at 9 electrode sites. Photic stimulation was administered at three frequency levels. The primary findings were consistently lower frontal delta and theta activity in the impulsive group as well as a different topographical pattern of beta activity between the groups. These differences appeared to be independent of photic stimulation. Personality analyses indicated significantly greater hostility and lifetime history of aggression in the impulsive group. Taken together, the personality and EEG results suggest some similarity between the present impulsive group and research on groups regularly exhibiting premeditated aggression. These results provide unique insight into the construct of impulsivity and its role in the expression of specific subtypes of aggressive behavior.

Latent structure of the Wisconsin Card Sorting Test: a confirmatory factor analytic study.

The present study represents the first large scale confirmatory factor analysis of the Wisconsin Card Sorting Test (WCST). The results generally support the three factor solutions reported in the exploratory factor analysis literature. However, only the first factor, which reflects general executive functioning, is statistically sound. The secondary factors, while likely reflecting meaningful cognitive abilities, are less stable except when all subjects complete all 128 cards. It is likely that having two discontinuation rules for the WCST has contributed to the varied factor analytic solutions reported in the literature and early discontinuation may result in some loss of useful information. Continued multivariate research will be necessary to better clarify the processes underlying WCST performance and their relationships to one another.