A network analysis of mechanisms of change during exposures over the course of intensive OCD treatment.

Exposure and response prevention (ERP) is an evidence-based treatment for obsessive-compulsive disorder (OCD). Theories for how it works vary in their emphasis on active mechanisms of change. The current study aimed to clarify mechanisms of change in ERP for OCD using network analysis, comparing ERP networks at the start and end of intensive treatment (partial hospital and residential). In our sample of 182 patients, the most central node in both networks was engagement with exposure, which was consistently related to greater understanding of ERP rationale, higher willingness, and less ritualization, accounting for all other variables in the network. There were no significant differences in networks between the start and end of treatment. These results suggest that nonspecific parameters like facilitating engagement in exposures without ritualizing and providing a clear rationale to clients may be key to effective treatment. As such, it may be useful for clinicians to spend adequate time underscoring the need to eliminate rituals to fully engage in exposure tasks and explaining the rationale for ERP prior to doing exposures, regardless of theoretical orientation. Nonetheless, findings represent group-level statistics and more fine-grained idiographic analyses may reveal individual-level differences with respect to central mechanisms of change. Other limitations include demographic homogeneity of our sample.

Therapist perceptions of experiential training for exposure therapy.

BACKGROUND: Despite evidence for its efficacy, exposure therapy for anxiety is rarely used in routine care settings. Efforts to address one major barrier to its use - therapists' negative beliefs about exposure - have included therapist-level implementation strategies, such as training and consultation. Experiential training, in which therapists themselves undergo exposures, has recently demonstrated feasibility, acceptability and preliminary effectiveness for increasing exposure use. AIMS: This study aimed to assess: (1) therapists' perceptions of experiential training and (2) barriers and facilitators to implementing exposure following training. METHOD: Therapists who underwent experiential training (n=12) completed qualitative interviews and quantitative questionnaires. Interviews were coded using an integrated approach, combining both inductive and deductive approaches. Mixed methods analyses examined how themes varied by practice setting (community mental health versus private practice) and exposure use. RESULTS: Results highlight how therapist-level factors, such as clinician self-efficacy, interact with inner- and outer-setting factors. Participants reported positive perceptions of exposure after training; they noted that directly addressing myths about exposure and experiencing exposures themselves improved their attitudes toward exposure. Consistent with prior literature, issues such as insufficient supervisory support, organizational constraints, and client characteristics made it challenging to implement exposures. DISCUSSION: Results highlight the benefits of experiential training, while also highlighting the need to consider contextual determinants. Differences in responses across practice settings highlight areas for intervention and the importance of tailoring implementation strategies. Barriers that were specific to therapists who did not use exposure (e.g. hesitancy about its appropriateness for most clients) point to directions for future implementation efforts.

The Use of Intensive Longitudinal Methods in Research on Suicidal Thoughts and Behaviors: A Systematic Review.

OBJECTIVE: Intensive longitudinal methods (ILM), such as ecological momentary assessment (EMA) and daily diary, involve repeatedly assessing individuals over short periods of time and have been increasingly used to study suicidal thoughts and behaviors (STBs). Suicidal thoughts have been shown to vary over short periods of time and reports of STBs are subject to negative biases. Therefore, ILM are important methodological tools for studying STBs, ones that capture enhanced precision and realism of data compared to traditional survey methods. The present systematic review aims to provide a comprehensive overview of ILM used to study STBs, including the various EMA and daily diary methodologies used, the feasibility of those methodologies, and the ethical considerations in this line of research. This review also summarizes the characteristics of descriptive STB outcomes specific to the ILM data collection period. METHODS: A thorough search of PubMed and PsycINFO was conducted up to May 2020, resulting in twenty-eight papers reviewed. RESULTS AND CONCLUSIONS: The review of the studies showed that ILM are largely feasible and do not have a negative impact on participants. In addition, the reviewed studies revealed unique aspects of STBs, such as the variability of suicidal thoughts, that suggest that ILM are important methodologies to use when studying STBs. Gaps in the research and recommendations for future research are discussed.HighlightsIt is feasible to use ILM to study suicidality.ILM do not have a negative impact on participants with suicidality.Few studies have used ILM to study suicidality in diverse samples.

Online Resources Used by Medical Students, a Literature Review.

This article was migrated. The article was marked as recommended. Purpose: To summarise research pertaining to the use of online resources by medical students throughout the course of their studies in a literature review. Method: Twenty studies published between 2003-2017 were identified for inclusion in the review. All reviewed papers reported on medical students use of online resources for their studies, both in preclinical and clinical settings. Results: Of the studies initially identified, twenty studies focusing on medical students were included and reviewed. The online resources, most frequently mentioned were UpToDate (35%); Epocrates (35%); Medscape (25%), Google (25%); PubMed (20%); Micromedex (20%); Wikipedia (15%); PEPID (10%); Dynamed (10%). Fourteen studies linked the use of online resources to their accessibility and reliability. In nine studies students reported that online resource use enhanced clinical management and diagnostic accuracy. Conclusion: Research on the use of online resources by medical students is largely limited to their use in clinical settings. As technology and learning evolve there is an increased need for students to be able to access such resources online and have the required teaching to understand how best to utilise them.

Metabolic theory of ecology successfully predicts distinct scaling of ectoparasite load on hosts.

The impacts of parasites on hosts and the role that parasites play in ecosystems must be underlain by the load of parasites in individual hosts. To help explain and predict parasite load across a broad range of species, quantitative theory has been developed based on fundamental relationships between organism size, temperature and metabolic rate. Here, we elaborate on an aspect of that 'scaling theory for parasitism', and test a previously unexplored prediction, using new data for total ectoparasite load from 263 wild birds of 42 species. We reveal that, despite the expected substantial variation in parasite load among individual hosts, (i) the theory successfully predicts the distinct increase of ectoparasite load with host body size, indicating the importance of geometric scaling constraints on access to host resources, (ii) ectoparasite load appears ultimately limited by access-not to host space-but to host energy, and (iii) there is a currency-dependent shift in taxonomic dominance of parasite load on larger birds. Hence, these results reveal a seemingly new macroecological pattern, underscore the utility of energy flux as a currency for parasitism and highlight the promise of using scaling theory to provide baseline expectations for parasite load for a diversity of host species.

Using species distribution models to define nesting habitat of the eastern metapopulation of double-crested cormorants.

When organisms with similar phenotypes have conflicting management and conservation initiatives, approaches are needed to differentiate among subpopulations or discrete groups. For example, the eastern metapopulation of the double-crested cormorant (Phalacrocorax auritus) has a migratory phenotype that is culled because they are viewed as a threat to commercial and natural resources, whereas resident birds are targeted for conservation. Understanding the distinct breeding habitats of resident versus migratory cormorants would aid in identification and management decisions. Here, we use species distribution models (SDM: Maxent) of cormorant nesting habitat to examine the eastern P. auritus metapopulation and the predicted breeding sites of its phenotypes. We then estimate the phenotypic identity of breeding colonies of cormorants where management plans are being developed. We transferred SDMs trained on data from resident bird colonies in Florida and migratory bird colonies in Minnesota to South Carolina in an effort to identify the phenotype of breeding cormorants there based on the local landscape characteristics. Nesting habitat characteristics of cormorant colonies in South Carolina more closely resembled those of the Florida phenotype than those of birds of the Minnesota phenotype. The presence of the resident phenotype in summer suggests that migratory and resident cormorants will co-occur in South Carolina in winter. Thus, there is an opportunity for separate management strategies for the two phenotypes in that state. We found differences in nesting habitat characteristics that could be used to refine management strategies and reduce human conflicts with abundant winter migrants and, at the same time, conserve less common colonies of resident cormorants. The models we use here show potential for advancing the study of geographically overlapping phenotypes with differing conservation and management priorities.

Decoupled effects (positive to negative) of nutrient enrichment on ecosystem services.

Eutrophication is a widespread phenomenon that disrupts natural ecosystems around the globe. Despite the general recognition that ecosystems provide many services and benefits to humans, little effort has been made to address how increasing anthropogenic eutrophication affects those services. We conducted a field experiment to determine the effect of nutrient enrichment on five ecological services provided by a model coastal system, a shallow seagrass community near Mobile Bay, Alabama (USA): (1) the provision of shelter for fauna; (2) the quality of food provided to first-order consumers; (3) quantity of food provision to first-order consumers and O2/CO2 exchange; (4) producer carbon and nitrogen storage, and (5) water clarity. The results showed a severe negative impact on seagrass density and biomass, which greatly reduced the structural complexity of the community and provision of shelter to fauna. Water clarity and the standing stock of producer carbon were reduced in the fertilized area in comparison with the control area. In contrast, nutrient addition did not affect in any consistent way the total quantity of food available for first-order consumers, the net exchange of O2/CO2, or the standing stock of producer nitrogen in the community. The nutritional quality of the food available for first-order consumers increased with fertilization. These results show that the impacts of nutrient enrichment on the services provided by natural systems may be disparate, ranging from negative to positive. These findings suggest that management policies for anthropogenic eutrophication will depend on the specific ecosystem service targeted. In the case of shallow seagrass beds, the loss of biogenic habitat and drastic impacts on commercially important fauna may be sufficiently alarming to warrant rigorous control of coastal eutrophication.