Evaluation of delay discounting as a transdiagnostic research domain criteria indicator in 1388 general community adults.

BACKGROUND: The Research Domain Criteria (RDoC) approach proposes a novel psychiatric nosology using transdiagnostic dimensional mechanistic constructs. One candidate RDoC indicator is delay discounting (DD), a behavioral economic measure of impulsivity, based predominantly on studies examining DD and individual conditions. The current study sought to evaluate the transdiagnostic significance of DD in relation to several psychiatric conditions concurrently. METHODS: Participants were 1388 community adults (18-65) who completed an in-person assessment, including measures of DD, substance use, depression, anxiety, posttraumatic stress disorder, and attention-deficit hyperactivity disorder (ADHD). Relations between DD and psychopathology were examined with three strategies: first, examining differences by individual condition using clinical cut-offs; second, examining DD in relation to latent psychopathology variables via principal components analysis (PCA); and third, examining DD and all psychopathology simultaneously via structural equation modeling (SEM). RESULTS: Individual analyses revealed elevations in DD were present in participants screening positive for multiple substance use disorders (tobacco, cannabis, and drug use disorder), ADHD, major depressive disorder (MDD), and an anxiety disorder (ps < 0.05-0.001). The PCA produced two latent components (substance involvement v. the other mental health indicators) and DD was significantly associated with both (ps < 0.001). In the SEM, unique significant positive associations were observed between the DD latent variable and tobacco, cannabis, and MDD (ps < 0.05-0.001). CONCLUSIONS: These results provide some support for DD as a transdiagnostic indicator, but also suggest that studies of individual syndromes may include confounding via comorbidities. Further systematic investigation of DD as an RDoC indicator is warranted.

Consistent evidence of indirect effects of impulsive delay discounting and negative urgency between childhood adversity and adult substance use in two samples.

RATIONALE: Exposure to adverse life experiences (ACEs) is robustly associated with problematic alcohol and other drug use. In addition, both ACEs and substance use have been independently associated with impulsivity. OBJECTIVE: To examine whether impulsivity is implicated in the link between ACE and adult substance use in two samples. METHODS: The primary sample was a cohort of community adults (N = 1431) who completed a one-time in-person assessment. A second sample was crowdsourced using Amazon Mechanical Turk (N = 3021). All participants were assessed for ACEs using the Adverse Childhood Experience Questionnaire and for current alcohol and other drug use. Given its multidimensional nature, impulsivity was assessed using the UPPS-P measure of impulsive personality traits, Go/NoGo (GNG) task (in-person community adult sample only), and delay discounting (Monetary Choice Questionnaire [MCQ] in the community adults and Effective Delay-50 [ED50] in the crowdsourced sample. Structural equation modeling was used to examine the hypothesized indirect effects for the measures of impulsivity between ACEs and substance use. RESULTS: In the community adults, significant indirect effects were observed from ACEs to substance use via UPPS-Negative Urgency (ß = 0.07, SE = 0.02, 95% CI [0.04, 0.10]), and the MCQ (ß = 0.02 SE = .01, 95% CI [0.01, 0.03]). In the crowdsourced sample, significant indirect effects were observed from ACEs to substance use via UPPS-Negative Urgency (ß = 0.05, SE = .01, 95% CI [0.04, 0.07]), UPPS-Premeditation (ß = 0.04, SE = .01, 95% CI [0.02, 0.05), and the ED50 (ß = 0.02, SE = .01; 95% CI [0.01, 0.03]). CONCLUSION: These findings provide consistent evidence that decrements in regulation of negative emotions and overvaluation of immediate rewards indirectly link ACE and substance use. These robust cross-sectional findings support the need for elucidating the underlying neural substrates implicated and for longitudinal evaluations.

Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation.

OBJECTIVE: Substance use disorders (SUD) are frequently comorbid with other psychiatric conditions, but a comprehensive diagnostic assessment is often not feasible clinically. Efficient psychometrically-validated screening tools exist for commonly comorbid conditions, but cutoff accuracies have typically not been evaluated in addiction treatment settings. This study examined the performance of several widely-used screening measures in relation to diagnostic status from a clinical interview to identify and validate cutoff scores in an inpatient SUD treatment setting. METHOD: Participants were 99 patients in a large residential SUD treatment program in Ontario, Canada. Participants completed a screening battery, including the Patient Health Questionnaire - 9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7), and Post-Traumatic Stress Disorder Checklist-5 (PCL-5), and underwent a semi-structured diagnostic clinical interview. Receiver operating characteristic curves were used to determine optimal cutoff scores on the screening tool against the interview-based diagnosis. RESULTS: Area under the curve (AUC) was statistically significant for all screens and were as follows: PHQ-9 = 0.70 (95% CI = 0.59-0.80), GAD-7 = 0.74 (95% CI = 0.63-0.84), and PCL-5 = 0.79 (95% CI = 0.66-0.91). The optimal accuracy cutoff scores based on sensitivity and specificity were: PHQ-9 ≥ 16, GAD-7 ≥ 9, the PCL-5 ≥ 42. CONCLUSIONS: In general, the candidate screeners performed acceptably in this population. However, the optimal cutoff scores were notably higher than existing guidelines for depression and PTSD, potentially due to the general elevations in negative affectivity among individuals initiating SUD treatment. Further validation of these cutoff values is warranted. PUBLIC HEALTH SIGNIFICANCE: This study provides modified screening cutoff scores for major depression, anxiety disorders, and post-traumatic stress disorder in addiction treatment settings.

Hypnotically induced auditory hallucinations and the mouth-opening maneuver: a failure to duplicate findings.

OBJECTIVE: The authors sought to replicate the part of a study by Bick and Kinsbourne in which hypnotically induced auditory hallucinations in normal volunteer subjects were abolished by requiring the subjects to open their mouths. METHODS: Sixty-four normal volunteer subjects were hypnotized, and an attempt was made to induce auditory hallucinations. The subjects in whom hallucinations were successfully induced were then asked to perform the mouth-opening maneuver and the control maneuvers of putting their fingers in their ears or squeezing their eyes shut in an effort to end the hallucinations. RESULTS: Sixteen subjects reported having hallucinations. None of them reported that a hallucination was abolished by opening the mouth or closing the eye; four reported ending hallucinations by putting their fingers in their ears. CONCLUSIONS: Opening the mouth does not affect auditory hallucinations induced by hypnosis in normal persons. The most likely reason for the discrepancy between the results of this experiment and those of the Bick and Kinsbourne study is that the design of the latter study was faulty because it permitted demand characteristics to influence the results.

The effects of an expectancy state on the fate of applications and psychotherapy in an outpatient setting.

This study describes an attempt to influence the outcome of outpatient psychotherapy by offering pretherapy information to application. The sample consisted of more than 1,300 applicants; the pretherapy information, in the form of a printed leaflet, was included with the application blank for alternate cases. The results suggest that the pretherapy information tended to discourage the completing of application blanks. Among those patients who eventually participated in psychotherapy, pretherapy information had no effect on the duration of treatment or on treatment outcomes as rated by the therapists. Incidentally, the data indicate that having health insurance has a strong, positive effect on the number of treatment interviews.

A reversal of hypnotically "refreshed" testimony: a brief communication.

A case is briefly presented in which questioning under hypnosis led to a positive identification of an accused rapist when the victim had previously been uncertain. During the trial, the victim was first certain, then reverted to her prehypnotic uncertainty. An appeal from the conviction of the defendant was denied on the grounds that the witness' uncertainty meant that the hypnotic intervention was harmless error. It is possible that this decision may not be entirely justified.

Some additional light on the childhood sexual abuse-psychopathology axis.

This exposition is an attempt to unravel the complexities of the relationship between childhood sexual abuse and adult psychopathology. Four facets of the relationship are examined in some detail: (a) the extent of childhood sexual abuse; (b) the probability that sexual abuse in childhood will result in psychopathology in the adult; (c) the reliability of early life memories in later life; and (d) the role of recovered memory of trauma in the healing process. The conclusions of this logico-empirical analysis are that first, government statistics tend to underestimate the extent of childhood sexual abuse, whereas independent surveys tend to overestimate it. Estimating prevalence is further complicated by variations in the definitions of key terms. Possibly the only safe conclusion is that true prevalence cannot be reliably determined. Second, empirical investigations of childhood sexual abuse conclude that not all victims are emotionally injured. A substantial number of these investigations find that a majority of victims suffer no extensive harm. Other variables such as family dynamics are involved; there may be only a few cases in which emotional harm results from sexual abuse as a single factor. Third, memory research suggests that memory in general is a dynamic, reconstructive process and that recall of childhood events is particularly vulnerable to distortion. Memory cannot dependably produce historical truth. Last, there is some clinical evidence that abreaction of a traumatic event in adulthood may have a remediative effect. Similar evidence for childhood trauma is lacking. The belief in the healing effect of recalling and reliving a childhood trauma depends on the therapist's orientation.

The hypnotic relationship: an investigation of compliance and resistance.

The purpose of this investigation was to assess the ability of hypnotic Ss to voluntarily resist a neutral suggestion when a monetary reward is offered for resistance. 19 of 40 Ss (47.5%) successfully resisted after money was offered by the "resistance instructor." The correlation between resistance/compliance and hypnotizability was -.44 (high hypnotizables were more likely to comply). Ss' impressions of the hypnotist tended to be positive; impressions of the resistance instructor tended to be neutral. There was a tendency for nonresistors to have a more positive view of the hypnotist but it is not as marked as was found in an earlier study (Levitt & Baker, 1983).

Sexual counseling. What the busy physician can, and cannot, do.

Patients with sexual problems often seek help first from their family physician. Before referring these patients, the physician should determine the kind of dysfunction present and whether it might successfully be treated in the general office setting. Secondary impotence can often be overcome by simple reassurance or by a program of frequent sexual foreplay and avoidance of actual intercourse. A stop-start method of reconditioning has had some success in the treatment of premature ejaculation. Anorgasmia is a commonly reported female complaint. If caused by inadequate foreplay, counseling and interpersonal discussion should lead to successful resolution. There is some evidence that anorgasmia in some cases may result from clitoral adhesion or underdevelopment of the pubococcygeus muscle. Both conditions may be simply remedied.

Some conditions of compliance and resistance among hypnotic subjects.

Five experimental approaches to the resolution of the century-old Bernheim/Janet dispute and the issue of involuntariness or coercion (the classical suggestion effect) are presented. Four experiments are reported that follow one of the approaches: attempts to induce hypnotic subjects to resist suggestions made in trance. The design is one in which a "resistance instructor" proposes a reward for the resisting subject. Tentative inferences from the results are that the classical suggestion effect is found with a small number of subjects; for a larger number of subjects there is no classical suggestion effect, and for many subjects the outcome is equivocal. Relational factors in the hypnotic dyad influence responsiveness in the subject, the effect being least for those whose susceptibility is high.