Posttraumatic stress disorder arising after road traffic collisions: patterns of response to cognitive-behavior therapy.

Road traffic collisions (RTCs) are common precipitants of posttraumatic stress disorder (PTSD). Two preliminary studies suggest that cognitive-behavior therapy (CBT) is, on average, effective in treating this disorder, although the major patterns of treatment outcome remain to be identified. Such outcomes might include treatment response, partial response, and response followed by relapse. To identify these patterns. 50 people with RTC PTSD completed a 12-week course of CBT, with outcome assessment extending to 3-month follow up. Dynamic cluster analyses revealed 2 replicable patterns of outcome: one for responders (n = 30) and one for partial responders (n = 20). Partial responders, compared with responders, tended to have more severe pretreatment numbing symptoms and greater anger about their RTC, along with lower global levels of functioning, greater pain severity and interference, and greater depression and were more likely to be taking psychotropic medications. Responders and partial responders did not differ in homework adherence, number of sessions attended, therapist effects, or stressors occurring during therapy or in the presence or absence of RTC-related litigation. Implications for enhancing treatment outcome are discussed.

Psychological and pharmacological treatments of social phobia: a meta-analysis.

A meta-analysis of psychological and pharmacological treatments for social phobia was conducted to evaluate whether the various treatments differ in their efficacy for treating social phobia, whether they are more effective than wait-list and placebo controls, whether rates of attrition differ, and whether treatment gains are maintained at follow-up. A total of 108 treatment-outcome trials for social phobia met inclusion/exclusion criteria for the meta-analysis. Eleven treatment conditions were compared: wait-list control, pill placebo, benzodiazepines (BDZs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors, attention placebo, exposure (EXP), cognitive restructuring (CR), EXP plus CR, social skills training, and applied relaxation. The most consistently effective treatments for social phobia were pharmacotherapies. BDZs and SSRIs were equally effective and more effective than control conditions. Dropout rates were similar among all the active treatment conditions. Assessment of the durability of treatment gains for pharmacotherapies was not possible because an insufficient number of drug studies included follow-up data. The treatment gains of psychological therapies, although moderate, continued during the follow-up period. BDZs and SSRIs seem to be effective treatments for social phobia, at least in the short term. Recommendations for future research include assessing the long-term outcome for pharmacotherapies and evaluating the inclusion of a cognitive-behavioral treatment during the drug tapering period.

Causal modeling of relations among learning history, anxiety sensitivity, and panic attacks.

We used structural equation modeling (SEM) to test the hypothesis that childhood instrumental and vicarious learning experiences influence frequency of panic attacks in young adulthood both directly, and indirectly through their effects on anxiety sensitivity (AS). A total of 478 university students participated in a retrospective assessment of their childhood learning experiences for arousal-reactive sensations (e.g., nausea, racing heart, shortness of breath, dizziness) and arousal-non-reactive sensations (i.e., colds, aches and pains, and rashes). SEM revealed that learning history for arousal-reactive somatic symptoms directly influenced both AS levels and panic frequency; AS directly influenced panic frequency; and learning history for arousal-non-reactive symptoms directly influenced AS but did not directly influence panic frequency. These results are consistent with the findings of previous retrospective studies on the learning history origins of AS and panic attacks, and provide the first empirical evidence of a partial mediation effect of AS in explaining the relation between childhood learning experiences and panic attacks in young adulthood. Implications for understanding the etiology of panic disorder are discussed.

Evaluation of the Yale-Brown Obsessive Compulsive Scale (YBOCS-hd) for heavy drinking with mild to moderately dependent alcohol abusers.

BACKGROUND: Many similarities have been noted between urges and desires to drink heavily and obsessive-compulsive disorders (OCD). Based on such similarities, Modell et al. (1992) developed the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd), a modified version of YBOCS, to assess obsessions and compulsions related to heavy drinking. Evaluation of the YBOCS-hd has been limited to more severely dependent alcohol abusers. METHODS: The present study used a self-administered version of the YBOCS-hd to evaluate (1) the severity of drinking-related obsessive compulsive symptoms with mild to moderately dependent alcohol abusers (problem drinkers), and (2) whether end-of-treatment changes in YBOCS-hd scores would be related to within-treatment functioning. RESULTS: Results indicated that problem drinkers have lower alcohol-related Obsessive and Compulsive subscale scores than did more severely dependent drinkers, but higher scores than did non-problem drinkers, supporting the construct validity of the YBOCS-hd. In addition, at the end of treatment, the YBOCS-hd scores of alcohol abusers who drank at low-risk levels during treatment were significantly lower than the scores of those who drank at high-risk levels. Lastly, exploratory factor analysis did not provide support for the two purported YBOCS-hd subscales (Obsessive, Compulsive). Instead, the analysis yielded a single general factor and a second factor that contained two questions measuring heavy drinking. CONCLUSIONS: Despite the fact that total YBOCS-hd scores covaried with drinking, neither the total YBOCS-hd pretreatment score nor the two subscale scores predicted functioning at the end of treatment. The present results call into question the utility of the YBOCS-hd, because a single item measuring the heaviness of drinking was as useful as the total YBOCS-hd and its two subscales in relating changes during treatment to end-of-treatment functioning for problem drinkers. However, although the YBOCS-hd does not predict changes in drinking, it may have value as an indirect measure of drinking in situations where direct measurement of alcohol consumption is undesirable (i.e., direct measurement might be reactive). Because the present findings are derived from problem drinkers, further research is needed to confirm the factor structure of the YBOCS-hd with clients who represent a broader range of alcohol problem severity.

The effect of pre-exposure to food cues on the eating behavior of restrained and unrestrained eaters.

This study investigated the effect of pre-exposure to two types of food cues (olfactory and cognitive) on food intake by restrained and unrestrained eaters. Subjects were exposed to either no cue, an olfactory cue, a cognitive cue or a combination of the two types of food cues for ten minutes prior to eating. Restrained eaters ate significantly more than did unrestrained eaters after exposure to the food cues. There was no difference in food intake when there was no pre-exposure to the cues. Although baseline subjective ratings were equivalent for both groups of subjects, after cue pre-exposure, restrained subjects, in keeping with their increased consumption, indicated a significantly greater craving, liking, and desire to eat the cued food (pizza) than did the unrestrained subjects. These findings suggest that restrained eaters are more sensitive and reactive to food cues than are unrestrained eaters. The food cues appeared to generate an appetitive urge to eat in restrained eaters.

Food preferences and desire to eat in anorexia and bulimia nervosa.

OBJECTIVE: To determine whether eating disordered patients and controls differ in visual analog scale (VAS) ratings of liking and desire to eat various foods and whether ratings differ according to caloric or macronutrient content of the foods. METHOD: Fifty-five female inpatients with eating disorders and 15 controls rated their liking of and desire to eat 50 common foods at admission and discharge using 100-mm VAS. RESULTS: All patient groups rated their desire to eat high-calorie foods significantly lower than their desire to eat low-calorie foods whereas controls rated their desire to eat high- and low-calorie foods equally. Patients also differed from controls more in ratings of desire to eat than in liking when foods were classified according to macronutrient content. In restricting anorexics (N = 25), ratings of liking and desire to eat for high-fat/low-carbohydrate (CHO) and high-fat/high-CHO foods were not significantly correlated at admission. Disparity in correlations between restrictors, bulimics (N = 18), and controls was attenuated with treatment while anorexics with bulimic features (N = 12) became less like controls from admission to discharge. DISCUSSION: Differences in the way patients and controls perceive foods should be borne in mind during the treatment process. Furthermore, since patients had not completely normalized by discharge, treatment strategies should emphasize acceptance of foods varying in macronutrient and caloric content, as intake of a varied diet is of key importance in regaining and maintaining good health.

Olfactory dysfunction in anorexia and bulimia nervosa.

Fifty-five eating-disordered women and 16 normal controls participated in this study to determine whether olfactory function is altered in patients with food-restricting anorexia, anorexia with bulimic features, and bulimia nervosa. Olfactory function was assessed using the University of Pennsylvania Smell Identification Test and by determining phenyl ethyl alcohol odor detection thresholds. Only the very low-weight anorexics showed impairments in their identification and detection of odors. This group's olfactory function did not improve from admission to discharge despite significant weight gain. Although, overall, smoking had only a minor influence on olfactory function, the very low-weight anorexic smokers had the lowest scores of all subjects. Since higher-weight anorexics did not show such impairments, the results suggest that the severe and prolonged starvation experienced by the very low-weight anorexics caused or contributed to intractable deficits in the olfactory system and that these deficits are compounded by smoking.

Eating style and eating behaviour in adolescents.

The relationship between eating style, attitudes towards food and food intake was investigated in 846 British adolescent schoolchildren. Eating style was assessed with the Dutch Eating Behaviour Questionnaire, attitudes towards food with a series of specially prepared questions, and food intake with a diet history taken by a dietitian. The results showed that restraint, external and emotional eating were associated with very different profiles of attitudes and behaviour. Restrained subjects had a higher body weight, more negative attitudes towards food, a lower likelihood of overeating and a lower overall energy intake. External eaters had a lower body weight, positive attitudes to food, and reported a higher energy intake. Emotional eaters fell in between in some ways, with some signs of situational loss of control combined with a negative attitude towards overeating. While external eating appeared to be attenuated by restraint, emotional eating was enhanced by it. The implications of these eating styles for later patterns of eating and weight are discussed.

Food intake, hunger, and satiety after preloads in women with eating disorders.

Food intake, food selection, macronutrient intake, sensory-specific satiety, and ratings of hunger and satiety were measured after high- and low-energy salad preloads (2414 kJ, or 172 kJ) or no preload to determine whether patients with eating disorders compensate appropriately for different energy intakes. Subjects were female patients with a DSM-III-R diagnosis of anorexia nervosa with bulimic features or bulimia nervosa, or non patient, normal-weight, nondieters (n = 9/group). At a self-selected lunch 30 min after the preloads, all of the groups reduced intake after the high-energy preload, with the bulimics showing the best compensation. The anorexics chose low-energy foods and in some conditions ate a smaller proportion of fat than did the other groups. The bulimics ate more high-energy foods than did the anorexics. The anorexics demonstrated sensory-specific satiety only after the high-energy salad and the bulimics only after the low-energy salad. Overall, these data suggest that while many of their responses to food are abnormal, patients with eating disorders have some capacity to respond to physiological hunger and satiety cues.

Gender differences in eating behavior and body weight regulation.

Gender differences in food intake and selection first appear in adolescence. Men consume more calories than women, and the sexes have different eating styles, which indicate that women have been socialized to eat in a more feminine manner. Women experience more food-related conflict than men do, in that they like fattening foods but perceive that they should not eat them. Pressures to be thin are present in early adolescence, as noted by dieting behavior starting in very young girls. Women experience more dissatisfaction with their body weight and shape than men do. Sociocultural and psychological factors may be important in the etiology of eating disorders, which are much more prevalent in females than in males. Thus, further studies of gender differences in eating behavior will be important for understanding the etiology of eating and body-weight disorders and for designing gender-appropriate treatments.

Effects of temperature and mode of presentation of juice on hunger, thirst and food intake in humans.

Foods differ in their satiating effects; temperature and mode of presentation may be factors important for these differences. We tested the effects of these two variables in normal weight, non-dieting males and females using vegetable juice. The juice was offered as a preload, with females receiving 300 g and males receiving 400 g under conditions that systematically varied temperature (60-62 degrees C vs. 1 degrees C) and presentation (served in mug vs. bowl with spoon); a no-preload condition was also included. Each preload was followed within 5 min by a second course of grilled cheese sandwiches. In the males, intake was significantly lower after cold but not hot preloads in comparison to the no-preload condition; however, intakes following the hot and cold preloads did not differ significantly. Males also reported a significantly greater decline in thirst following the cold preloads. Temperature of the preloads did not affect food intake or thirst in the female subjects. Neither group was affected by the mode of presentation of the preloads. Further studies with other types of foods and drinks are needed to clarify whether temperature or mode of presentation can influence satiating efficiency.

Foods with different satiating effects in humans.

The aim of this study was to identify particular properties of foods that can affect satiety. Two levels (50 and 200 kcal) of three preloads (tomato soup, melon, cheese on crackers) were given just before two different second courses (macaroni and beef casserole, grilled cheese sandwiches), allowing us to examine the effects of caloric level, energy density, and sensory-specific satiety on food intake in normal weight, non-dieting males. Eating time and initial palatability ratings were held constant. Soup was found to reduce second course intake significantly more than the other preloads. This reduction could be partially accounted for by the low energy density of tomato soup; however, soup reduced intake more than the melon preload, which was matched for energy density. Sensory-specific satiety did not explain the satiating efficiency of the soup. Thus, during a meal, tomato soup is more satiating than the melon and cheese on crackers. Further studies are required to determine why these foods have different effects and to determine whether soup consumption can be beneficial in weight reduction programs.

Effects of drinks sweetened with sucrose or aspartame on hunger, thirst and food intake in men.

Forty-two nondieting adult males were given 8 or 16 oz of lemonade, sweetened to equal intensity with either aspartame or sucrose, or the same volumes of water, or no drink. Subjects were separated into three groups receiving the drinks at different times: with a self-selection lunch, or 30, or 60 min before lunch. Food intakes did not differ when subjects received the drinks with lunch; however, when the calories from the drinks were included, intake was significantly greater with the sucrose-sweetened lemonades than in the other conditions. When subjects received the drinks 30 or 60 min before lunch, food intakes were not significantly different. Appetite ratings were not different among the conditions. When the drinks were consumed with the meal, the 8-oz sucrose-sweetened lemonade differed from the other drinks in that it did not significantly reduce thirst. The results indicate that in nondieting males, aspartame in concentrations similar to those in commercially available drinks did not increase hunger ratings or food intake. However, caloric drinks taken with lunch increased total energy intake in that meal. Also, sucrose-sweetened drinks may decrease thirst less than water or aspartame-sweetened drinks when taken with a meal.